You may have heard the terms “cortisone shot” and “epidural steroid injection” and wondered if they’re the same.
Although people use the terms interchangeably, cortisone is actually a type of medicine that’s part of an epidural injection.
You can get a shot of cortisone in any of your major joints, but an epidural injection is specifically for your spine. However, it’s not the same as an epidural someone receives during labor.
What Is a Cortisone Shot?
Cortisone is a steroid. Specifically, it’s a corticosteroid. Corticosteroids can reduce joint pain and swelling.
When a provider gives a cortisone shot, they combine the steroid with a type of anesthetic. Cortisone shots help treat conditions like:
- Arthritis.
- Bursitis.
- Carpal tunnel syndrome.
- Tendinitis.
- Tennis elbow.
How does a cortisone shot work?
Cortisone shots can help relieve pain for several weeks at a time. The steroid calms your body’s immune system and helps reduce inflammation in your joints.
The shot goes directly into the joint, so it can target your specific pain, including:
- Hand and wrist pain.
- Foot pain.
- Knee pain.
- Neck and back pain.
- Shoulder pain.
Cortisone shots can help if physical therapy and medicine aren’t enough. It can help postpone surgery or give a joint time to heal. But cortisone itself doesn’t fix whatever problem is causing the joint pain.
What Is an Epidural Steroid Injection?
An epidural steroid injection (ESI) is a cortisone shot specifically for neck and back pain. It helps people who have radiating nerve pain, which is pain that originates with a spinal issue but spreads to the arms and legs.
A typical cortisone shot can go into any joint, but an epidural steroid injection is specifically for your epidural space.
The epidural space is just outside your spinal cord, between your vertebrae and the outer layer that protects your spinal cord.
The provider uses x-ray guidance (fluoroscopy) to ensure the injection gets to the right place. The provider first injects a contrast dye to check that the medication is flowing exactly where it needs to go.
What conditions can epidural steroid injections treat?
Epidural steroid injections are for nerve pain.
Nerve pain is different than muscle pain. Nerve pain happens because of compression, often called a pinched nerve. Too much pressure on the nerve can cause pain, numbness, and weakness.
Epidural steroid injections can treat:
- Cervical radiculopathy — Pain that radiates from the neck (cervical spine) to the arm.
- Thoracic radiculopathy — Pain that radiates from the middle of the back to the chest.
- Lumbar radiculopathy — Pain that radiates from the lower back into the leg (also called sciatica).
Spinal disc problems, such as a herniated disc, can put pressure on nerve roots. This is why epidural steroid injections can treat disc issues. But really, the injection is targeting the nerve.
What Else to Know About Cortisone Shots and Epidural Steroid Injections
Steroid injections of cortisone into your joints or your epidural space can help relieve pain. However, they aren’t always the right treatment for everyone.
Is a steroid injection for pain right for me?
You and your doctor will decide together if a steroid pain injection is a good treatment for you.
Most people who get a cortisone shot or epidural steroid injection have tried other treatments first. This may include anti-inflammatory or nerve medication and physical therapy.
For people with knee pain from arthritis, cortisone injections can help prolong joint replacement therapy. For people who have physical jobs and limited time off, steroid injections can help them better plan for surgery.
However, if you’re planning on having joint restoration treatments, cortisone injections may not work for you. This is because joint restoration tries to preserve existing cartilage. (This is different than joint replacement, which removes damaged cartilage.)
If you have a bleeding disorder, uncontrolled high blood pressure, or diabetes, you should avoid cortisone and epidural injections.
You should also avoid steroid injections if you have an infection. Steroids temporarily suppress your immune system, making it harder for your body to heal.
What are the side effects of epidural steroid injections?
Any injection comes with a small risk of infection. For spinal injections, risks include:
- Bleeding.
- Increased blood sugar levels (temporary).
- Nerve injuries.
- Spinal headache.
- Pain from inflammation of the arachnoid (a membrane that surrounds your spinal cord nerves).
Will a cortisone shot or epidural steroid injection hurt?
As with any injection, you might feel some pressure or discomfort. Your provider will talk you through what to expect.
Keep in mind that cortisone and epidural steroid injections have a mix of steroid and numbing medicine. The numbing medicine helps relieve pain at the time of the injection.
The numbing medicine continues to provide pain relief until the steroid medicine kicks in. The steroid itself may take a few days to start providing pain relief.
How often can I get steroid pain injections?
There’s no exact rule about how often you can get steroid pain injections. But most providers have guidelines they follow.
Many providers set a limit of three to four cortisone shots a year.
Guidelines for epidural steroid injections are similar. Some doctors advocate for no more than four epidural steroid injections per year. Others allow up to six.
With cortisone shots specifically, surgery is a better option for some than getting shots year after year.
Who can give cortisone shots and epidural steroid injections?
Providers who often give cortisone shots include:
- Primary care doctors.
- Sports medicine doctors.
- Orthopaedic surgeons.
Epidural steroid injections require more training. Providers who give these shots include:
- Anesthesiologists.
- Interventional radiologists.
- Neurologists.
- Orthopaedic surgeons.
- Pain management specialists.
UPMC Orthopaedics and Sports Medicine has a range of providers who can talk to you about your joint pain or nerve pain. We have locations in:
- Southwest Pa.
- Northwest Pa. and Western New York
- Central Pa.
- North Central Pa.
- West Central Pa.
You don’t have to live with chronic pain. Contact us today to learn about your options.