Arthritis, tendinitis, bursitis—if you have a pain condition that ends in “itis,” it’s likely you’ve been offered cortisone treatments in the past. Cortisone injections are typically one of the first (and only) options offered by traditional doctors. While these injections might offer temporary benefits, they do so at the expense of potential long-term complications.

If you’re skeptical about receiving a cortisone injection or are eager to discover treatment alternatives, you’ve come to the right place. Learn more about why cortisone has become the go-to therapy for pain management, why it’s not the fix-all solution others claim, and how treatment alternatives can save you trouble down the line.

Why is Cortisone Such a Common Treatment?

Also referred to as a steroid shot or corticosteroid, cortisone is typically injected into joints, tendons, ligaments, and other soft tissue for pain management. It’s a type of steroid that can lower inflammation to potentially lessen pain. It’s not actually a “pain reliever” at all, just a method to reduce side effects that may lead to pain. So, if it’s not a pain reliever, why is it so popular? 

Cortisone has become the most common pain relief technique both in Canada and around the world due to its safety profile. Scientists are familiar with how cortisone works in the body and believe it can be effective in some pain conditions. One look at the Prescribing Information for cortisone reveals just how many conditions it can be used to treat.

Since cortisone is considered relatively safe and far less invasive than surgery, it’s usually one of the first pain management techniques your family doctor or pain management specialist will recommend. Today, cortisone is considered a “stop-gap” for patients who are in pain. An injection won’t improve a patient’s condition, but it may temporarily limit pain symptoms. 

How Does Cortisone Work for Pain Management?

Now that we’ve established that cortisone itself is not a pain reliever, it’s important to take a look at how these injections work for pain management. When injected into a tissue, like a ligament in the knee or tendon in the shoulder, cortisone does two things. First, it completely turns off or alters the immune system in that area, so that it cannot react to normal stressors. This turns off inflammation.

Technically speaking, many pain symptoms stem from inflammatory conditions. If you have arthritis, tendinitis, or any other inflammatory condition, cortisone is meant to decrease the inflammation. It impairs the immune system’s ability to respond to any injury within that tissue for three to six months, or as long as it takes for the immune system to recover in the area.

Next, cortisone stops the production of new collagen in the injected area. Collagen is a crucial protein that’s in tendons, ligaments, cartilage, and any other tissue that can be a pain generator. It’s also the key to normal healing, repair, and cell turnover. Cortisone prevents the production of new collagen, which essentially means it will not allow the impacted tissue to heal. 

Why is Cortisone Not a Fix-All Solution?

Though cortisone might seem like a quick fix, it’s truly not all it’s chalked up to be. For one, cortisone truly is a quickfix. In the short-term, cortisone can mask pain symptoms because the affected tissue has become metabolically inactive. This is a medical way of describing tissue that’s not actively healing or regenerating, but instead sitting there and absorbing stress.

Even more, cortisone injections typically do not last that long—especially if you’ve been receiving injections for months on end. Though you might have your normal life back for a few weeks, your immune system may quickly recover in the affected area and your inflammation can turn right back on. Cortisone does nothing to heal the tissue or underlying injury, just hide the symptoms. 

Plus, if cortisone does work well for you, you could be doing more harm than good while feeling pain-free. You might start playing sports, running, or picking up your little ones, despite still having injured tissue. Then, you’re out of luck if you stress the tissue and need your body to produce more collagen, simply because cortisone impairs that ability. 

Lastly, cortisone injections can be highly problematic for those who are diabetic or struggle with blood sugar. A well-known side effect of cortisone is a worsening of blood sugar. If you opt for cortisone injections, anticipate that you may need to work with your doctor to alter your insulin regimen or locate dietary solutions that could help with blood sugar control.  

What Alternative Treatments Are Available for Pain Management?

The drug information for cortisone clearly states that corticoid therapy is not curative and will not be able to heal an underlying injury or condition. The drug facts also note that cortisone is “rarely indicated as the primary method of treatment” and should be used adjunctively with other therapies. Fortunately, there might be a better option altogether. 

The most common alternative therapy for pain management is prolotherapy. Prolotherapy is a regenerative medicine injection to treat musculoskeletal injuries and chronic conditions like arthritis. Consisting of a safe, hyperosmotic solution that stimulates local immune cells in an affected area, prolotherapy is essentially the exact opposite of cortisone.

Though injected into the affected area like a corticosteroid, prolotherapy ramps up the immune system response to a potentially damaged structure that didn’t heal right the first time. It increases collagen production to promote healing and helps eliminate old scar tissue or fibrotic tissue that causes pain. In other words, it helps your body mend injured tissue rather than mask pain. 

How Are Alternatives Different from Cortisone?

When I speak with my patients, I like to refer to cortisone injections as a cycle. First, you’re a candidate for a steroid injection. Next, it’s helpful for a time. Then, you’re told you can only receive a few per year. You’re stuck on a circular track with one stop—the injections your doctor schedules. You plan your entire life around this one stop, until the cortisone no longer has the same effects.

Alternative treatments do not put patients through this cruel cycle. Instead, prolotherapy helps patients put their wellness first by amplifying the natural ability to heal damaged tissue. Prolotherapy also does not have any effect on blood sugar, even though it’s designed around dextrose, a sugar. Compared to cortisone, prolotherapy is safer for diabetic patients.