"Doctor, it hurts. Can you fix it now? I don't want to do anything to help myself, I'm not interested in therapy, and I would like to continue with all my current activities. I don't want to try any other complimentary or conservative treatments you suggest, I just want to feel better NOW! I want some cortisone."
This is an all too common refrain in the clinic. Patients no longer have any patience. We live in a society that demands instant, on the spot answers, where any delay is intolerable.
A large review of published literature was published in The Lancet in 2010 and found "that cortisone injections reduced pain in the short term compared with other interventions, but this effect was reversed at intermediate and long terms."
In 2013, Coombes et al, published a randomize control trial in JAMA concluding that a "corticosteroid injection resulted in lower complete recovery or much improvement at 1 year vs. placebo injection and greater 1-year recurrence." Similar results were found at 4 and 26 weeks.
We also know that cortisone injections are not without other risks. According to the American Orthopedic Society for Sports Medicine (AOSSM) possible risks include: infection, osteonecrosis, nerve damage, tendon weakening or rupture, osteoporosis, flair up of pain and inflammation, deterioration of cartilage within a joint, and skin and soft tissue thinning around the injection site.
Further the AOSSM also notes that "[c]ortisone is not a pain-relieving medication, but rather works by minimizing the body's reaction to inflammation. When the inflammation is lessened, the pain is also... If cortisone injections are used, they must be combined with the appropriate rest period and rehabilitation to gain the best results."
I'm not saying that cortisone doesn't have a place in medicine. I have seen some good results in the use of cortisone for pain control when nothing else worked, however, I do question the attitude that a quick fix injection is the way to go.
1)http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61160-9/abstract
2) http://jama.jamanetwork.com/article.aspx?articleid=1568252&link=xrefhttp://
3) www.sportsmed.org/uploadedFiles/Content/Patient/Sports_Tips/ST%20Cortisone%20Injections%2008.pdf
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