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WHAT IS CORTISONE?

Cortisone is a hormone produced by a small gland on top of the kidney called the adrenal gland. Cortisone is essential to the proper functioning of your body, particularly when under stress. Its absence is known as Addison’s Disease, which without treatment is fatal. Cortisone is a normal body product; therefore, there are no allergic reactions. In cases of people with severe allergies, it is one of our most effective treatment tools. Cortisone by itself is rarely used today as it is relatively short acting and of low potency. Semi-artificial cortisone derivatives, such as DepoMedrol, Celestone, Kenalog, and a number of others are used with increased benefits and fewer side effects. Cortisone falls into a group of chemicals called steroids. It is very different from anabolic steroids commonly abused by weight lifters or competitive athletes. The cortisone/steroid injections, used in medical practice, fall into three broad categories: articular injections, “trigger point” injections, and epidural steroid injections.
How is cortisone effective?
Cortisone is useful in suppressing inflammation in the short term. But if persistent irritation or the aggravating event is still perpetuating the problem, the inflammation may certainly return. It is the hope that cortisone will help reduce excess inflammation which often hinders a more rapid healing, and in the spine could actually cause more damage. Once the inflammation has been eliminated or reduced the body’s healing must occur for long term success. It is Dr. Suthar’s medical opinion that the body must repair and “heal thyself” for long-term success from any form of injection. Local injections do have certain concerns including a weakening effect on tendons if injected directly into them. It can also soften cartilage when injected into a joint. (Information comes from experiments on animals and not human beings.)
How many injections are needed?
In spite of surrounding folklore, there is no specific limit to the number of cortisone shots that can be given. Most experts in the field of pain management have indicated anywhere from 3-6 injections per year. Practical and common sense approaches are always important in considering additional injections. For example, if the shot does not work, then why repeat it? If it does work, cortisone is extremely effective and not too many shots are needed. Often injections are mixed with an anesthetic (lidocaine) to provide a diagnostic answer to the “pain generator.” A pain generator is an anatomic structure which is actually the source or cause for pain. There is a limit to the amount of cortisone given in one dose, even if injected in several areas of the body. Naturally, the dose varies depending on the size and physical condition of the person.
What are the different types of injections?

Articular or joint injections are preceded by an aspiration (withdrawing joint fluid or blood). Joints commonly injected are the shoulder, knee, ankle, and small joints of the hand and foot. Most injections can be followed by a booster injection two to four weeks later. A good limit is three injections over a three-month period of time at a single location (an injection to another location can be done at any time).

A “trigger point” injection is an injection in the soft tissue or myofascial structures of the body. Injections can also be performed at the insertion of a tendon area or into the bursa surrounding such joints as the shoulder, knee, or the hip.

An epidural steroid injection is another category of cortisone injection. It is neither a joint nor “trigger point” injection, but rather an injection inside the bony column of the spine surrounding the dura (the sac that encloses the spinal cord and spinal nerves). Lumbar epidural injections involve a relatively simple technique. They are done several inches from the spinal cord and are unlikely to be accompanied by complications, except perhaps a headache. Cervical (neck) epidural injections are similar to lumbar epidural injections except there are additional risks associated with this area of the body. Epidural steroid injections are useful for a variety of back conditions including sciatica, arthritis, degenerative disc problems, and spinal stenosis. All spinal injections should be performed with the use of an x-ray C-arm machine.

Is the injection painful?

It has been Dr. Suthar’s experience and approach that most injections can be performed with very little pain. By adhering to proper precautions and using analgesics the discomfort of injections can be greatly reduced. What one experiences as “pain” during the injections is also variable and often not related to pain but more to anxiety of the unknown. Injections into an area that is already inflamed are more sensitive and can therefore create some discomfort that typically lasts only a few seconds. Some areas, such as the hand and foot, are particularly sensitive and a freeze block is used before the injection. Other areas, such as the knee and shoulder, are much better tolerated, and many patients hardly feel anything.

Cortisone shots are generally accompanied by an anesthetic such as Marcaine or Lidocaine. This deadens the area and surrounding tissues where the shot should be placed (the pain will go away over about 2-3 hours while the anesthetic works). Most people who have reactions or allergies to cortisone rarely have the reaction to the anesthetic agent of the epinephrine (adrenaline), which may be contained in some forms of the injection. Epinephrine can cause tachycardia (rapid heartbeat) in some patients. For others, the sight of a needle will cause this reaction, and the feeling of being faint is often misinterpreted as an allergic reaction.

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13710 Olive Boulevard (Primary Office)
Chesterfield, MO 63017
Telephone: 314-469-PAIN (7246)

Fax: 314-469-7251
Exchange: 314-441-6965 (for after-hour Emergencies Only)

Hours:
Monday thru Friday
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