One common option used to prevent inflammation is the use of a corticosteroid. Corticosteroids can injected intravenously, absorbed by the skin, and inhaled, as well as taken orally. These cortisone related medications work by limiting capillary dilation, and decreasing the permeability of the capillaries and arterioles. As a result, leukocyte aggregation is decreased and the release of pro-inflammatory cytokines is limited. This can cause a drastic reduction in pain both short and long term depending on the condition being treated. Oftentimes, multiple shots are administered over the course of the inflammatory condition, and sometimes the case can be cured completely if the inflammation is localized to a small area. This is seen in conditions such as bursitis and tendonitis.
It is also suspected that corticosteroids play a role in inhibiting the release of arachidonic acid, the reactant utilized by the cox-1 and cox-2 enzymes. The inhibition of this reactant leads to a decrease in the prostaglandins produced by these enzymes, and thus leads to a decrease in inflammation. Since the cox enzymes are still being inhibited by the lack of arachidonic acid reactant, it occurred to me
that this will likely affect TA1 production, which will in turn affect platelet aggregation. Cortisone is shown to have other side affects as well - cartilage degeneration can occur due to continuous injection to a specific area over time. As with all types long term steroid ingestion, bone loss can occur, but Muscle soreness is the most common side effect. Overall, corticosteroid treatment is an extremely helpful option for patients with extreme pain due to inflammation.
Below is a link to a video I found of a cortisone injection in the knee - I found it especially relevant because In years to come, I may be using similar treatment for my ACL and Meniscus injuries if I continue to have pain.
https://www.youtube.com/watch?v=6lM6Nt0AmwQ
References:
Derrer, David. "Cortisone Injection (Corticosteroid Injection) of Soft Tissues and Joints." WebMD:Arthritis Center. 27 Dec. 2013. Web. 28 Nov. 2014.
Salines, Jes Et al. "Corticosteroid Injection of Joints and Soft Tissues" Medscape. 20 Aug. 2014 Web. 28 Nov. 2014
Great post. As we discussed in class, the side effects of over the counter drugs are often underestimated, especially among the general public. It seems as though for any ailment the solution is just to pop an Advil or Tylenol. As you said, in some cases corticosteroids can be a great substitute for the other anti-inflammatories discussed. However, like any drug they also carry their risks.
ReplyDeleteSomething I would like to see in the future would be a more widespread knowledge of which anti-inflammatories are right for the individual based on their specific risk factors. For example, you described how cox-2 inhibitors would be the wrong choice for someone that is at risk for cardiac problems. I believe that simple information like that could be very beneficial for the public. Instead of seeing every anti-inflammatory as interchangeable drugs that you take to cure a headache, they could know which specific drug would be the safest for them.
I definitely agree Joel, risk factors exist that increase the chances of health complications with both corticosteroid and cox-1/cox-2 treatments. A patient who is prone to bone fractures would definitely want to avoid corticosteroids due to its tendency to cause loss of bone mass. Knowing the risk factors for every treatment is essential.
DeleteHello Michael,
ReplyDeleteI had heard of cortisone cream for helping with itchiness from bug bites but I had not heard of injections of cortisone to help with pain from inflammation. I guess it's obvious I don't get into sports very much. I am glad they have those treatments for people who have chronic joint pain from injuries. Like Joel had mentioned, people have different risks and having options is good and being informed is even better.
It's cool that there have been so many types of cortisone treatment developed so it can be used for a variety of conditions! having options is always a good thing with medical treatment!
DeleteMichael, thanks for the informative post. my grandmother has regularly turned to cortisone injections to treat her severe knee pain. She does happen to be overweight, and avoids walking because of the discomfort it causes, but she has mentioned how incredibly painful her injections are. I went ahead and watched a few more videos and came across one were the professional administering the injection explains why some areas are more sensible than others when making the injection, mainly because of cartilage location. This is logical of course, but it is interesting he had it figured out based on his own practice. now I'm wondering if my grandmother's doctor considers these things.
ReplyDeletemario, i'm glad your grandmother is able to benefit from cortisone injections! Elderly patients who have more difficulty with physical therapy always seem to benefit from the cortisone. And yes, more senstive tissue with more nerve endings will be more painful upon injection than an area with less nerve tissue.
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ReplyDeleteVery interesting post Mike! In endocrine we recently learned that corticosteroids could be used as an anti inflammatory and an immune suppressor but we didn't spend a whole lot of time on it so it is good to see some more about it. It is interesting that you posted about this because it is actually something have seen done before in the clinic but i didn't know much about it at the time. I like when we talk about things i have seen in the clinic because the more i learn about all these different treatments the more i can understand why someone may have been treated with one thing rather than another.
ReplyDeleteThanks Dan! Endocrine PSIO sounds like a cool class. Cortisone shots are extremely common and are used very frequently by orthopedic specialists... ive seen a few myself during shadowing.
DeleteGood job , Mike! I wonder if corticosteroid injections would be too effective and suppressing immune function if used to treat systemic inflammation. I've noticed their uses in deep tissue localized pain and inflammation. As for platelet aggregation, would corticosteroids exhibit similar effects to nonselective COX inhibitors? that's something I've never considered. Parasympathetic drive, and corticosteroids by extension, tends to be highest in cases that would result in bleeding, so this hypothesis is troubling if true.
ReplyDeleteHi Michael!
ReplyDeleteI found this post very interesting and really relevant due to the fact that I am really involved in soccer and the number of knee issues, especially in girls, is quite is very common. What I was wondering is how long do the cortisone shots work? Is it something that will sustain a person for 10 or so years or would the side effects lead a person to not be able to do partake in these shots for that long?
I too am interested in knowing how long the effect of the corticosteroid shot will last. It seems like the injection would be a more expensive procedure and much more invasive compared with taking NSAIDs. It seems like this treatment would be a last option. That being said, it is good to see an alternative to NSAIDs after studying the various harmful side effects.
ReplyDeleteI liked the explanation you gave of how corticosteriods prevent the immune system from accessing an area. I wonder how this relates to immune suppression generally though as this is the side effect I have heard the most about. Are all capillaries less permeable and therefore the immune system cannot access any part of the body? Are there other effects on the immune cells themselves? This is something I would like to learn more about.
ReplyDeleteGreat post! I do think corticosteroids are a great option, and they really work for a lot of people. But I also have one concern about them from my experience working in PT. I see a lot of patients in the clinic who don't understand why their doctor sent them to PT instead of just giving them another steroid injection. These patients usually fail to see the value of PT for helping their pain because they are so accustom to going to the doctor, getting a shot, and experiencing relief much faster. While I don't disagree with the use of these injections, I do think that some patients should be considered for PT first before they start receiving regular shots to manage their pain. Generally, PT can help a lot of pain conditions for longer than an injection can, and I think some patients should learn that they can do something about their pain themselves before they rely on shots to do it for them.
ReplyDeleteadorri,
DeleteThis is a clear issue in health care today and i'm glad you pointed it out. There is a major lack of understanding about which treatments should be used and when they should be used. While a cortisol shot reduces pain caused by inflammation temporarily, it does not cause any actual progression to occur. Physical therapy on the other hand works to strength and build up the injured area over time.
Thanks for the post! I have see corticosteroids work their magic in my family and friends for issues ranging from plantar fasciitis to skin conditions. On that note I always though it was interesting how diverse the route of administrations are - your discussion about vessel permeability offers a compelling account of why that might be.
ReplyDeleteMichael,
ReplyDeleteI liked the video that was included at the end. For me, it definitely reminded me of why I didn't end up getting a cortisone shot for my thumb with that needle! I ended up opting for UCL reconstruction and PT afterwards other than a quicker "fix" with the corticosteroid. I agree with adorri, above, in that PT should definitely be not only considered but more often promoted than a cortisone shot. I think that even though surgery and PT have a long recovery road and the cortisone shot is essentially instant pain relief, PT is still going to be a better option because it is for the long term where the shot is temporary.
Cortisone shots are DEFINITELY painful so i don't blame you for not getting one in the thumb as this is already a sensitive area of tissue. depending on the injury of course, I definitely agree with you that Physical therapy is a better long term solution than a cortisone shot...cortisone is more for pain relief where as physical therapy solves the underlying problem.
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