Cortisone Injections: May Do More Harm than Good
Tennis elbow is not exclusive to tennis players; anyone who frequently twists an arm or carries a heavy briefcase can develop it. Painful knees and knee injuries are also not exclusive to football or baseball players, but whoever you are and whatever your injury, most sufferers of these conditions have been offered a cortisone shot as treatment. Recent surveys in Canada, United States and Britain show that injections of the steroid, which rapidly dulls pain and fights inflammation, are the preferred first line of treatment among most orthopaedic specialists. But growing evidence suggests that the injections, while effective in the short term, can frequently worsen the condition in the months that follow, raising interesting questions about the risks of quick fixes for pain.
For decades tennis elbow was thought to be caused by inflammation in the tissues around the joint. Newer science, however, including biopsies of the sore tissue, shows little inflammation, except in the very early stages of the injury. Instead, it is thought to involve degeneration of the tissues: If the joint is used repeatedly and strenuously, the body cannot repair any resulting minor damage and more damage occurs, and the tendons that hold the elbow together begin to fray and buckle. The pain can be debilitating and last for months.
As a treatment, cortisone shots are appealing because they are easy to obtain; any general practitioner can administer them. But the most sophisticated study to date of tennis-elbow treatments finds that cortisone seems to be counterproductive. In the study, published this summer in BMC Musculoskeletal Disorders, 177 people who had developed tennis elbow randomly received two cortisone shots three weeks apart or a placebo injection on the same time schedule. Both groups also received elbow massages and began a six week series of at-home arm stretches and exercises. A third group was administered a therapeutic dose of BCM-95 Circumin (a highly potent form of turmeric), and a fourth group was not treated at all to serve as a control.
The volunteer’s elbow function and pain were tested periodically until they were a year out from treatment. At the first check in at six weeks, the men and women who had received cortisone reported much less pain than those in the other three groups, all of which, on average, reported elbow soreness that was only slightly lower from the start. But in another six weeks, the cortisone-treated elbows were as sore as everyone else. And six months after treatment, those who had received cortisone treatment had significantly more elbow pain than the BMC-95 Circumin group or the control group. In fact, the BMC-95 Circumin group felt that their condition was totally healed at this point in the study. None of those participants reported any pain left.
Why cortisone might have worsened people’s tennis elbow remains uncertain, says Morten Olaussen, a family-medicine physician and researcher at the University of Oslo in Norway who is co-author of the new study. But it is plausible that the drug could impede structural healing within the joint. The good news is that after one year, almost everyone’s elbow recovered, whatever their treatment or lack of it. In fact, the control group had the same success rate—close to 80 per cent—after a year as all other participants. These results suggest that despite many of our instincts to do something—anything—when we hurt, the cheapest and most efficacious treatment for tennis elbow could turn out to be time. Just avoid painful activity and wait and see.
When you injure a part of your body you receive pain and this pain is a signal to treat that part of the body carefully and not put stress on it. However, the pain signal to the brain also causes a mass stimulation of new cells to the injured area to start the healing process. Cortisone works by suppressing our immune system response so we do not feel the pain. But by doing this it also stops our body from producing new cells to regenerate the injured tissue. This is the reason why the pain goes away at the start but the healing process is actually delayed by the cortisone injection.
Next time you injure yourself, think mild pain relievers for a few days, Circumin for a few months but never cortisone injections.