Cortisone shots are injections that can help relieve pain and inflammation in a specific area of the body. They contain a corticosteroid medication and a local anesthetic. While cortisone shots can be very helpful for treating conditions like arthritis, tendinitis, and bursitis, many patients worry about how much they will hurt.
What is a cortisone shot?
A cortisone shot, also known as a steroid shot, is an injection of a corticosteroid and local anesthetic medication into a joint, tendon, or bursa. The shot can help treat pain and inflammation caused by conditions like:
- Arthritis
- Tendinitis
- Bursitis
- Carpal tunnel syndrome
- Gout
- Neuralgia
The corticosteroid in the injection helps reduce inflammation that is often causing the pain. The local anesthetic numbs the area to relieve immediate pain. This allows for better mobility and use of the affected joint or area.
Do cortisone shots hurt?
Most patients tolerate cortisone shots well and experience only mild discomfort during the procedure. However, everyone’s pain tolerance is different.
Here is a general overview of the possible pain levels with a cortisone injection:
- Mild to moderate pain – Most people report the needle stick feels similar to having blood drawn. There may be mild to moderate pain or aching at the injection site for the first 1-2 days.
- Temporary increase in pain – Some patients may have a temporary increase in pain or inflammation for 24-48 hours before they start feeling relief. This is due to the medication dispersing in the tissue.
- Severe pain – A very small percentage of patients, less than 5%, experience significant pain with the injection or have pain that lasts more than 2 days afterwards. If this occurs, contact your doctor.
The potential pain and discomfort depends on several factors:
- Where the injection is given – Joints and bones generally hurt less than more sensitive areas like tendons.
- Gauge of needle – Thinner needles typically cause less discomfort upon insertion.
- Medication – The steroid and anesthetic combination is formulated to be comfortable for most people.
- Skill of provider – Experienced providers will inject in the least painful manner.
- Individual pain tolerance – Everyone feels pain differently.
What does the injection feel like?
Many patients describe a cortisone injection as feeling like a quick bee sting or ant bite. There is often a pinching feeling as the needle goes through the skin into the tissue below. After this brief discomfort as the needle enters, the actual injection of medication is typically not very painful.
Once the injection is complete, you may feel some mild residual aching or burning at the injection site. This normally fades within a few hours.
It is common to feel better pain relief on day two or three after the injection. This allows time for the corticosteroid to take effect at reducing inflammation.
What can affect the pain level?
Certain factors may make a cortisone shot more or less painful for patients:
- Location – Shots into thicker skin and fat, like the buttocks, usually hurt less than those into joints or tendons.
- Size of needle – Larger gauge needles cause more pain. Ask your provider to use the smallest size needed.
- Skill of provider – Having an experienced doctor, nurse, or technician perform the injection can help minimize discomfort.
- Number of injections – Some treatments require multiple injections, which may increase pain.
- Patient anxiety level – Being relaxed helps reduce discomfort. Increased anxiety can heighten pain.
- Skin numbing – Some providers use a cold spray or creams to numb the skin. This may reduce injection pain.
Pain management options
If you are worried about potential pain with a cortisone injection, talk to your healthcare provider about options to help minimize discomfort:
- Numbing cream – Topical lidocaine creams and sprays can numb skin prior to injection.
- Cold spray – Brief sprays of vapocoolant immediately before injection may reduce sensation.
- Smaller needle – Use the smallest gauge and shortest needle length suitable.
- Proper position – Place the affected area in a relaxed position during injection.
- Controlled speed – Slow, steady injections are generally less painful.
- Pressure – Applying light pressure to the site after removal of the needle.
- Post-injection care – Use ice packs and over-the-counter pain medication as needed.
Talk to your doctor about the options available at your facility. They can recommend the best ways to maximize pain control.
Does the needle size matter?
Yes, using a smaller gauge needle can help reduce injection pain for cortisone shots and most other types of shots. Needle gauges range from 13 gauge at the largest to 33 gauge at the smallest end.
A 25-27 gauge needle is best suited for most cortisone injections. This small needle width allows the medication to flow easily while minimizing pain receptors stimulated in the tissue.
Larger needles in the 18-21 gauge range may be needed for thigh and gluteal injections to reach deep tissue. But most joint and tendon injections should be performed with 25 gauge or smaller needle when possible.
Talk to your doctor about using the smallest needle and shortest length appropriate for your specific condition and injection site.
Needle Gauge Chart
| Gauge | Diameter |
|---|---|
| 13 | 2.41mm |
| 18 | 1.27mm |
| 21 | 0.82mm |
| 22 | 0.71mm |
| 25 | 0.51mm |
| 30 | 0.31mm |
As shown, the optimal 25 gauge needle has a very small 0.51mm diameter that causes little tissue disruption.
How long does the pain last?
The majority of patients have only minimal residual soreness for a day or two after a cortisone injection. Any moderate pain during the actual procedure typically goes away within a few hours.
It is possible to have some worsening of pain for the first 24-48 hours before you start to feel relief from the medication. This temporary increase in discomfort is due to the steroid dispersing within the tissue.
Contact your doctor if pain at the injection site lasts more than 2-3 days or seems to be getting worse rather than better with time. Persistent pain could indicate a complication like infection or injury.
Expected Pain Duration Timeline
- During injection – Mild to moderate pinching pain.
- Day of injection – Mild residual soreness possible.
- 1-2 days after – Potential mild increase in pain as medication starts working.
- 2-3 days after – Pain improving and relieved. Call doctor if pain worsens or persists.
Always let your doctor know if you experience severe pain during or after a cortisone injection, as further treatment may be needed.
Tips to minimize injection pain
While most cortisone shots are well-tolerated, you can take steps to help reduce discomfort:
- Use numbing cream on the skin before injection.
- Ask for smallest needle size possible.
- Have an experienced provider perform the injection.
- Use a relaxed position that opens up injection site.
- Distract yourself with conversation or music.
- Apply ice to the area before and after the shot.
- Take over-the-counter pain medication as needed after.
- Avoid moving the injected area for a day or two.
Talk to your doctor prior to the procedure about options available to help minimize any potential pain or discomfort.
Risks and side effects
Along with temporary pain at the injection site, other common side effects from cortisone injections include:
- Bleeding or bruising at injection site
- Facial flushing for 1-2 days
- Temporary increase in blood sugar levels
- Impaired immune response for several weeks
- Thinning of skin or soft tissue if multiple injections given
Rare but potentially serious risks include:
- Joint or tendon rupture
- Nerve damage
- Infection
- Allergic reaction
- Skin changes like depigmentation
Cortisone shots into unstable joints or tendons are more likely to cause complications. Discuss your specific risks with the provider performing the injection.
How many cortisone injections can you have?
There is no specific limit on the number of cortisone injections that can be given, but most experts advise caution with repeated shots.
For most people, a safe approach is to:
- Limit shots to 3-4 per year in a single joint or area
- Space out injections by at least 4-6 weeks if possible
- Avoid injecting the same site repeatedly in short succession
Risks increase with more frequent injections because it can lead to:
- Cartilage breakdown
- Tissue damage
- Thinning of ligaments and tendons
- Joint instability
Talk to your doctor about the ideal frequency to both maximize benefits and minimize complications for your condition.
Summary
For most patients, cortisone injections cause only brief, mild to moderate pain during the procedure. While the needle prick may sting, the actual injection is usually well-tolerated.
Ask your doctor to use numbing creams, smaller needles, and proper injection techniques to minimize discomfort. Any pain typically resolves within a few hours but can last 1-2 days.
While cortisone shots are generally safe and effective for reducing inflammation and pain, take care to avoid overuse and discuss the potential risks and side effects with your provider.
