Updated: May 15, 2021
If you've asked your doctor for a cortisone shot and they were reluctant, it's with good reason. Kris breaks down the mechanisms of action and the risks associated with this pain relief approach.
In the late 90's, I worked as a medical assistant and orthopedic technician at Harvard Vanguard. Working under then-chief, Robert Meigel, MD, we saw lots of osteoarthritis and frozen shoulders and
many patients would request cortisone injections. Now corticosteroids are available in a wide range
of forms: tablets, liquids, topical creams and oiments, aerosol sprays, and eye/ear drops. They are among the most widely used anti-inflammatory medicines, and mimic the adrenal gland's natural production of glucocorticoids (such as cortisol).
When issued in pharmacologic doses, corticosteroids are used short-term (1-3 weeks) under medical supervision, with little side effects. Its ability to squelch the inflammatory response is what makes them so popular. Its mechanism of action is believed to occur directly on the nuclei of the cell. Upon entering a cell, the drug binds to a glucocorticoid receptor in its cytoplasm. The resulting steroid-receptor combination then travels to the nucleus, and combines with specific sites to begin the transcription of DNA into messenger RNA, kicking off a production of enzymes and structural proteins that reduce the
signs and symptoms of inflammation regardless of its cause.
However, if you've asked your doctor for a cortisone shot and they were reluctant, it's with good reason.
Corticosteroids have other important functions in the body. One of which is maintaining blood glucose and liver glycogen levels in the body by naturally breaking down body tissue proteins and fats. When given in pharmacologic doses, this catabolic effect causes the body's muscles, tendons, bones, ligaments,
joint capsules and articular surfaces to break down - increasing the risk of osteoporosis, especially in post menopausal women.
By inhibiting fibroblast activity, they reduce connective tissue rebuilding and thin the skin. Injections into joints can damage articular cartilage, injections into tendons can reduce the sensitivity of golgi tendon organs and muscle spindles to stretch and tension changes - resulting in higher risk for tearing or rupture. Prolonged skin applications can reduce skin sensitivity, and if that wasn't enough to make you think twice,
other effects are immunosuppression, since corticosteroids are believed to inhibit migration of leukocytes and macrophages to the sites of inflammation.
Some of these side effects are serious and should be considered when discussing with your doctor. Discuss healthy lifestyle choices to minimize them during therapy, such as taking a Vitamin D supplement. Use care after your therapy too. It may take some time for your adrenal glands to adjust to producing its own supply of corticosteroids again. Fatigue, muscle aches, and light-headedness are common complaints
when not weaned off dosages gradually.