Key takeaways
- A cortisone flare, sometimes called a “steroid flare,” is a possible side effect of a cortisone injection. This can occur if the injection irritates your joint.
- When you experience a cortisone flare, the shot can cause intense pain at the injection site, especially at first. The pain usually shows up within a day or two of the shot.
- Cortisone flares may be manageable with at-home remedies like ice packs or over-the-counter (OTC) medications like ibuprofen (Advil). If the pain persists, contact your doctor.
Doctors often use cortisone injections to treat osteoarthritis pain in the joints, but they may also use them to help manage pain associated with tendon issues or conditions like trigger finger. The injections contain corticosteroids meant to decrease inflammation, which will often reduce the amount of pain you experience.
Common areas to receive the shot are the:
- knee
- shoulder
- hand
- wrist
- foot
Knowing what to expect from a cortisone shot and what side effects you might experience can help you plan for the treatment.
A 2022 study notes that the exact cause of cortisone flares isn’t known, but several theories exist, including:
- injury from the needle
- unintended placement of the shot
- an adverse reaction to the anesthetic that healthcare professionals use to numb the injection area
- an enhanced immune system response after the shot
It’s also possible that these flares are the result of crystallization. The corticosteroids in the injection are formulated as slow-release crystals to give you long-term pain relief.
However, the presence of these crystals may irritate the joint and cause pain around the area of the shot.
How common are cortisone flares?
Researchers estimate that cortisone flares happen in around 10% to 40% of people receiving corticosteroid injections.
It’s hard to predict whether you’ll have a steroid flare reaction after a cortisone shot. If a flare does occur, it’s likely to develop one or two days after an injection.
How long can a cortisone flare last?
Cortisone flares are generally self-limiting, meaning they’ll go away on their own. Research suggests that they last two days on average, although your experience may be different.
If you’re still in a lot of pain three to five days after you get the injection, contact your doctor.
There are a few things you can do to manage a cortisone flare at home:
- Apply an ice pack wrapped in a towel to the injection site for 15 to 20 minutes at a time to reduce inflammation.
- With your doctor’s advice, try OTC pain medications, such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol).
- Get plenty of rest.
If these strategies aren’t effective, contact your doctor.
After a cortisone shot, try to avoid using the affected joint for the next two days or as long as your doctor recommends. If the shot is administered in your knee, do your best to stay off your feet as much as possible and avoid standing for prolonged periods of time.
You’ll also need to avoid swimming or soaking the area in water. Opt for showers instead of baths in the days following the shot. Your doctor will tell you when you can return to your usual activities.
Unless a cortisone flare occurs, joint pain typically subsides quickly after the shot is administered. This is because the shot contains a pain reliever in addition to the corticosteroid.
Keep in mind that it’s important to space out your cortisone shots over the course of a year to prevent long-term complications. Your doctor may recommend waiting a few months in between injections.
Though pain at the injection site is common, you may also experience some other side effects, including:
- soreness in the muscle group surrounding the affected joint
- light bleeding at the injection site
- slight skin discoloration at the injection site
Some side effects of cortisone shots, such as bleeding, can occur right after receiving the shot. Others may take a day or two to appear.
In rare cases, the site of the injection may become infected within a week of the cortisone shot. This may cause symptoms such as:
- ongoing bleeding
- discharge
- swelling
- persistent skin discoloration
- hot skin
- fever or chills
If you notice these symptoms, get prompt medical attention.
Cortisone flares are a possible side effect of cortisone shots, and may cause intense pain for a few days after an injection.
You may be able to reduce the inflammation and pain at home with remedies like ice packs and OTC medications, but contact your doctor if the pain persists.