A steroid injection, also known as a cortisone or corticosteroid shot, is a common medical procedure used to deliver powerful anti-inflammatory medication directly to a specific area, such as a joint, tendon, or muscle. While often highly effective for reducing inflammation and pain, they are not without potential side effects. These reactions can range from mild and immediate to rare and longer-lasting, and the timeframe for their resolution is a common concern for patients.
Immediate and Short-Term Side Effects
Some of the most common side effects occur within the first few days after the injection and are typically temporary and mild.
- Injection Site Pain and Soreness: It is normal to feel some pain, swelling, or soreness around the injection site. This is often caused by the volume of fluid injected or the local anesthetic wearing off. For most people, this discomfort subsides within a few days.
- Steroid Flare: A brief and temporary increase in pain and inflammation, sometimes worse than the original symptoms, can occur in roughly one out of four patients. This "cortisone flare" is thought to be caused by the steroid medication crystallizing within the tissue. It typically resolves within 1 to 3 days.
- Facial Flushing: Some individuals, especially those assigned female at birth, may experience a temporary flushing or warmth in the face and chest. This is a harmless reaction that generally lasts for a few hours to a few days.
- Insomnia and Mood Changes: Corticosteroids can cause a temporary stimulant-like effect, leading to insomnia or heightened energy. Some people also report mood swings, feeling either very high or very low. These side effects usually clear up within a few days to a week.
- Blood Sugar Increase: For people with diabetes, a steroid injection can temporarily raise blood sugar levels for a few days. It is essential for diabetic patients to closely monitor their glucose and have a plan with their healthcare provider to manage this effect.
Mid- to Long-Term Side Effects
While less common, some side effects can last longer or appear weeks to months after the injection. These are often associated with repeated injections or higher doses.
- Skin Changes: At the injection site, rare side effects include thinning and lightening of the skin (hypopigmentation), or dimpling caused by fat atrophy. These changes can take up to a year to resolve, and in some instances, may be permanent.
- Immune System Suppression: Steroids work by suppressing the immune system's inflammatory response. A single local injection can mildly lower the body's defenses for about 1 to 4 weeks. With higher doses or more frequent injections, this effect could last longer.
- Menstrual Cycle Changes: Temporary changes to a woman's menstrual cycle, such as longer or heavier periods, can occur within 9 to 19 days following a corticosteroid injection.
- Tendon Weakening: Injections near a tendon carry a slight risk of tendon weakening or rupture, particularly with repeated treatments in the same area. This is why doctors typically limit the frequency of injections.
Comparison of Steroid Injection Side Effects
| Side Effect | Typical Duration | Influencing Factors | Management Strategies |
|---|---|---|---|
| Steroid Flare | 1–3 days | Individual sensitivity, medication type | Ice packs, rest, OTC pain relievers |
| Injection Site Pain | 2–4 days | Volume of injection, individual sensitivity | Ice packs, rest, pain medication |
| Facial Flushing | Hours–few days | Dose, individual hormonal response | Cool compresses, avoidance of alcohol |
| Insomnia/Mood Swings | Few days–1 week | Individual response to corticosteroid | Schedule morning injections, calming routine |
| Increased Blood Sugar | Several days | Pre-existing diabetes, dose | Close monitoring, adjusting medication |
| Skin Discoloration/Thinning | Up to 1 year (or permanent) | Injection technique, steroid potency | Avoiding frequent injections at same site |
| Immune Suppression | 1–4 weeks | Dose, injection site (systemic absorption) | Awareness of infection risks, especially post-surgery |
Managing Side Effects and When to See a Doctor
Most immediate side effects are manageable with simple home care. For injection site pain and steroid flares, resting the joint and applying intermittent ice packs for the first 24-48 hours is effective. Over-the-counter pain relievers like acetaminophen or ibuprofen can also help, but always consult your doctor first. If you experience insomnia or mood changes, establishing a relaxing bedtime routine can be beneficial. For those with diabetes, it is crucial to proactively discuss management of blood sugar with a healthcare provider before the injection.
While serious complications are rare, you should contact your doctor immediately if you notice signs of a serious infection, which include:
- Fever of 100.4°F (38°C) or higher
- Severe pain, swelling, or redness that lasts longer than 48 hours or worsens
- Any discharge or drainage from the injection site
Additionally, any sudden or significant weakness or loss of control, or an unusual pounding headache after a spinal injection, should be reported immediately.
Conclusion
For most patients, the side effects of a steroid injection are minor and resolve quickly within a few days to a week. The most common issues, like a "steroid flare" or injection site soreness, are well-managed with rest and ice. While some rarer side effects, such as skin changes, can be longer-lasting, serious complications are uncommon and typically associated with higher doses or frequent injections. By understanding the typical timeline and appropriate management strategies, patients can feel more prepared and empowered during their recovery. For more comprehensive information on steroid injections, consult your healthcare provider or visit reputable sources like the Versus Arthritis website.
