When cortisone injections were discovered in the 1940’s, it was considered the medical breakthrough for joint, tendon, and cartilage related pain. It continues to be the option offered by many physicians for injury and arthritis. However, even as early as the 1950’s research began to show cortisone is not the “magic bullet” it was thought to be. However, because of the popularity of an instant pain relief option, the research suggesting caution was ignored.
Cortisone is frequently used for conditions such as knee osteoarthritis, tennis elbow, shoulder pain, as well as neck and back pain. Medical doctors have been willing to use it for almost any type of soft tissue pain, but without making a dent in the actual rate of disease. Over 9 million people still suffer from knee osteoarthritis and it continues to be a leading cause of disability and medical costs.
How Cortisone Hurts Instead of Heals
Understanding the short term and long term effects of cortisone are the important first step in understanding the problems, and why you should not use cortisone for your pain. When injury occurs to tissue such as cartilage, tendon, and joints, cortisone shots can intercept this pain by shutting down the natural healing process in order to essentially numb the pain. It can stop pain, but not without interfering with the natural healing process leaving more damage after the effects of the shot wear off.
The Natural Response to Injury
When injury occurs, the body knows exactly what to do. At the injured site, the body signals for all the types of healing cells, this results in an influx of fluid carrying all the types of healing cells to the injury. With the increase in fluid and blood cells recruited for healing, the tissues swell. This is the classic redness and swelling that occurs immediately after an injury. As the healing cells do their work, this resolves and makes way for long-term strengthening of the area to begin. The cell signalling that occurs in the acute injury phase resulting in redness and swelling is also what signals the clean up and rebuilding phase. Without the first acute response, the body does not move on to clean up (get rid of extra body fluid from the area) and begin laying down new cartilage to strengthen the area and prevent future injury. There is no replacement for this natural healing process the body is so perfecting designed to do.
Faux Healing with Cortisone
If you have received a cortisone shot, you understand the often immediate pain relief that can occur. Particularly for athletes this has been a literal, and figurative “game changer” to be out of pain that quickly after an injury. As early as the 1950’s studies began to show quick relapse of injury after cortisone shots. Cortisone “faked” healing since when the pain is gone, most people assume the injury is healed. But, this is not the case with cortisone, it is a “faux” healer that takes the pain away, but does nothing to heal or strengthen the injury. In fact, it does just the opposite- it weakens the surrounding tissues and leaves you more susceptible to injury. In 2010 a large review of cortisone research was done which included over four dozen research articles all concluding cortisone decreased the rate of full recovery. Despite its ability to cover pain quickly without the use of addictive opioid medications, there was a 63% higher relapse rate of injury than those who did nothing or did physical therapy. The review also confirmed cortisone shots are counterproductive for conditions like tennis elbow.
A Call For The End of Cortisone
There are plenty in the mainstream medical community as well as the alternative and integrative medical community who are calling for the end of cortisone as a primary treatment option for arthritis, athletic injury and degenerative joint, bone and tissue diseases. This is not only because there are better options available that actually healing the tissue, but also because cortisone is causing more damage long term than most people were willing to admit in the medical community. Thankfully, many are becoming more reluctant in using it.
The Research for Stopping Cortisone
The body of research available for cortisone shots is extensive, and a few key studies are worth addressing. In 2003, a study looked at cortisone for osteoarthritis giving injections every 3 months over 2 years. This study by design, used radiography to measure the distances between bones to measure degenerative disease. This is actually a type of measure that is insensitive to any measures of soft tissue which is where degenerative diseases are actually occurring. The measuring tool used (radiography) was incorrect and has skewed the view of cortisone safety. The need for a similar study using the correct measuring tool (MRI) was in part to what led to the 2015 study reviewed in JAMA in 2017. The new study replicated the same frequency of injections and study length and showed cortisone caused greater cartilage volume loss in those given cortisone than those who received the placebo shot. In addition, those who got the cortisone shot showed no difference in knee pain vs. the placebo group.
LifeWorks Integrative Health understands the problems with cortisone and has a better way that actually heals your pain. Through our comprehensive assessment, we can understand the cause of your pain and develop the customized plan for you. Because we are a multidisciplinary integrative center, we can offer the blend of healing modalities to fit your needs ranging from rehab and chiropractic care to functional medicine and regenerative stem cell therapies. Don’t wait to get your pain healed and don’t settle for short term fixes that leave you in worse shape than when you started, like cortisone shots are proven to do.