Local corticosteroid injections are used to provide fast and effective reduction in pain and inflammation to restore function.
Most often the improvements are temporary and lasting up to 8 weeks.
The injections normally need to be provided as a combined treatment with the rehabilitation program for your condition including activity modification and a graduated exercise program.
This leaflet aims to provide you with the relevant information that you require to help make your decision on having a corticosteroid injection for your condition.
What are the steroid injections and how are they used?
Some steroids occur naturally within the human body. Artificial steroids provided by injections behave like natural steroids to reduce inflammation. These steroids are different to the steroids used by body builders.
Steroid injections are recommended for people with musculoskeletal pain and inflammatory arthritis. They can be used for managing pain and inflammation in osteoarthritis and for a range of soft tissue conditions.
Corticosteroid injections don’t treat the underlying cause of your pain and condition, but they help to treat and manage the symptoms.
There is a wide range of corticosteroids that are available, some are short acting and work almost immediately but give a short lived relief up to a week or so. There are long acting steroids which can take up to a week to work but can last for several months.
What are the benefits?
The main purpose of the corticosteroid injection is to reduce your symptoms and enable you to return to the activities you value and enjoy. The most common symptom is pain. Pain is a very complex sensation and not all pains will respond to corticosteroid injections. There are many other ways of reducing inflammation and pain, and you should be made aware of these.
What are the harms?
Harms relate to negative effects of healthcare. One potential harm is that the injection doesn’t achieve the anticipated benefit, such as a reduction in pain. This may be due to the condition being treated, the stage of the condition, and the presence of other health concerns.
Corticosteroid injections help reduce the pain for 20% of people or 1 in 5 people who have an injection. Another way of considering this is that the injection will help the people with the green faces, but not the people with the red faces.
Also, the injection may not help completely. For some ‘green faced people’ the injections only result in a very mild reduction in pain and only for a few weeks before the symptoms return.
What happens during my appointment?
The clinician will ask you a series of screening questions about your health and medical history for your appropriateness for the corticosteroid injection.
The clinician and you will need to sign a written consent for the agreement for the injection.
The clinician performing your injection will choose the most appropriate steroid medicine and dose for your symptoms and condition.
The clinician may include a small amount of local anaesthetic with the injection to help with your pain.
The clinician will usually inject the steroid directly into the area that is painful such as the joint or soft tissue. Most injections are quick and easily performed.
What happens after the injection?
Depending on the medication given you may experience your pain to be relieved immediately but may wear off after a couple of hours.
You may be advised to wait locally for up to 30 minutes after your injection to make sure you do not immediately feel unwell or have any reaction to the medication.
You may wish to organise transport home after the injection. You are advised not to drive for up to 48 hours or sometimes longer after the injection.
Following your injection, it is important to keep the area moving and to avoid strenuous and repetitive tasks for up to 2 weeks. After an injection into your shoulder, you will need to avoid lifting, pushing, pulling anything more than a light weight. After an injection into the leg, you will need to avoid running, excessive stair climbing, pushing heavy weights with your legs. You must follow the advice given to maximize the benefit of the injection.
It is helpful to engage in exercises that build stronger bones, muscle and tendons. It also improves lung and heart function, improves mood, reduces blood pressure and helps control blood sugars.
It is helpful to look into your lifestyle factors related to good nutrition, weight control, cessation of smoking, good sleep, and exercise as they are known to help the cells within your muscles, tendons and joints to be healthy.
Possible side effects of corticosteroid injections
Allergic reaction (anaphylactic shock)
This is extremely rare but is a medical emergency and is associated with difficulty breathing (and other symptoms). It is most likely to happen in the first 15 minutes after an injection (usually involving analgesic) but can happen up to 6 hours after the procedure. For this reason, you will need to remain in the clinic / reception for 30 minutes after the injection. If you have any difficulty breathing or any unusual symptoms you must tell us immediately. If it happens after you have left you must seek medical help immediately. Treatment involves another type of injection and this must be administered quickly. However, please be assured this is extremely rare.
Infection
An infection is also an extremely rare occurrence and may happen after any injection. If the area injected becomes red, swollen, hot, painful you must see your doctor or attend Accident and Emergency immediately. You may feel unwell and have a temperature. Take action immediately. Take this brochure with you to the doctor, as the injection you have had and the date of the procedure is documented.
Diabetes
If you have diabetes you may experience changes in your blood sugar levels. The clinician will discuss this with you before providing the injection. It is important that you monitor your blood sugars for up to 3-5 days after the injection, if you have any concerns please speak to your GP.
Facial flushing
This happens to about 5% or 1 in 20 people and involves circulation changes and the face becoming redder. This usually resolves within a day but may last up to 2 days. If it is not resolving please contact your doctor or physiotherapist.
Post-injection pain flare up
You may experience an increase in pain up to 24 hours after your injection. This can last a few days. You should take what you normally take for pain or discuss this with your doctor or pharmacist.
Menstrual disturbances
Following an injection some women may have missed period(s) or menstrual disturbances. If this does occur it normally settles quickly.
Local skin changes
Injections may cause some localised thinning of the skin or localised skin pigment colour changes around the site of the injection.
Repeated Injections
Repeated injections to the same area can cause weakening of the tendon structures and contribute to tendon rupture. Repeated injections to the joint can lead to destruction to the joint and cartilage structures.
Adrenal Insufficiency
Repeated injections can lead to altered function of the adrenal glands. These are located near the kidney and produce cortisol. Cortisol is vital for normal functioning of bodily systems including stress, blood sugars and immunity.
A minimum of 3 injections over a 12 month period could lead to higher than normal steroid causing a drop in cortisol. You must tell the injector of your injection history over the past 12 months and if you have an injection, you may be issued with a Steroid Emergency Card.
Vision changes
This is usually rare where you may get blurred vision, sudden loss of visual acuity or red eye you need to seek urgent medical advice with an ophthalmologist.
Mood changes
This is usually rare where you may experience changes in mood within a few days following your injection. If you notice levels of low mood with any thoughts of self-harm or suicidal thoughts seek urgent medical advice
Corticosteroid and Interactions with your other medications
The corticosteroid may interact with other regular medications that you may be taking, such as Non-steroidal anti-inflammatory medicines or high levels of aspirin, where it may affect their effectiveness or contribute to adverse effects. It is important your physiotherapist is aware of all your current medication and they may speak to your GP if there may be any concerns prior to considering you for a corticosteroid injection.
Corticosteroid and immunosuppression
Corticosteroid used in the injections may reduce your immunity and ability to fight infections. When the steroid is injected into the area a small of the steroid does pass through your body into the bloodstream, which would temporarily affect the body’s immune system. The evidence is unclear on the actual effect of this on you catching coronavirus or the severity of any infection if you did catch it.
If you are experiencing any symptoms of coronavirus or normal flu symptoms at the time of your appointment for the corticosteroid injection it is important to let your clinician know so this can be postponed.
It is advisable following your corticosteroid injection to avoid contact with people who have chicken pox or shingles, if you have not had it before. If you come into contact with anyone with an active infection, it is advisable to see your doctor straight away.
Therefore it is important that you follow public health guidance and normal measures to avoid getting infections such as coronavirus, chicken pox, or shingles with social distancing, careful hand hygiene few days before and few days after the injection.
If you have other risk factors that make you particularly vulnerable for any infection, it will be important to carefully discuss the risks and benefits of the injection with the clinician.
Covid-19 vaccinations and corticosteroid injections.
Following your vaccination for corona virus, your body will be mounting its own immune response and this can take a couple of weeks. It is advised not to have a corticosteroid injection for 21 days following your vaccination and 2 weeks prior to your vaccination to ensure your body’s immune response is not compromised.
We do not provide injections to patients to the following groups of patients:
- Those who are pregnant or breast feeding
- Those who are taking anti coagulation medications or have any condition which affects their blood clotting factors
- Those who are immunocompromised in their general health by cancer, HIV, liver or kidney conditions
- Those who are being currently treated for an active infection or recently completed a course of antibiotics
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If you have any questions or anything you would like to talk about regarding the injection you have had or something related to your condition, please discuss this with your doctor or physiotherapist.
If you would like to discuss any issues or concerns following your injection please contact The Central Administration Team, Edgware Community Hospital. Tel: 0208 732 6813 or 0208 349 7366.
If you require an urgent medical advice please contact NHS 111 or emergency services.
We are always looking for ways to improve the quality of our care.
Please feel comfortable to communicate with us or with PALS (The Patient Advice and Liaison Service) if you have any concerns.
Central London Community Healthcare NHS Trust, Ground floor, 15 Marylebone Road, London NW1 5JD
Phone: 0207 798 1300
E-mail: clchpals@nhs.net