Cortisone injections deliver powerful anti-inflammatory medication directly to a localized area of pain or inflammation. While the primary goal is local relief, many patients report systemic effects, including temporary fatigue or general malaise. This tiredness is a known side effect that occurs as the body adjusts to the presence of the synthetic corticosteroid.
The Systemic Effect of Corticosteroids
The fatigue experienced after a cortisone injection stems from the medication’s influence on the body’s natural hormone regulation system. Even when injected locally, a portion of the synthetic corticosteroid is absorbed into the bloodstream, where it circulates systemically. This systemic presence mimics the body’s natural stress hormone, cortisol, but at a much higher concentration.
The high level of synthetic hormone triggers a negative feedback loop on the Hypothalamic-Pituitary-Adrenal (HPA) axis, the pathway controlling cortisol production. The HPA axis interprets the injected steroid as an overabundance and signals the adrenal glands to temporarily halt natural cortisol production. This temporary suppression, called secondary adrenal insufficiency, is the physiological basis for the resulting fatigue until the HPA axis resumes normal function.
Typical Timeline for Post-Injection Fatigue
The duration of fatigue following a cortisone injection typically follows a predictable timeline. Fatigue often begins within the first 24 to 48 hours after the procedure, coinciding with the peak systemic absorption of the medication. This initial period may also involve other temporary side effects, such as facial flushing or a short-term increase in blood sugar levels.
For most individuals, the feeling of tiredness is transient and begins to resolve within three to seven days. However, the exact duration is highly variable, depending on the specific type of steroid used, the injected dosage, and individual metabolic rates. Fatigue can linger for up to two weeks as the HPA axis fully recovers and normal cortisol production stabilizes.
Variability is influenced by the location and number of joints treated, as a higher overall dose increases the likelihood of a systemic effect. Patients with pre-existing conditions, such as diabetes, may experience more pronounced fatigue due to the steroid’s temporary impact on blood glucose regulation. While HPA axis suppression can last up to four weeks, monitoring the body’s response over the first two weeks is usually sufficient to determine the recovery course.
Strategies for Managing Cortisone-Related Fatigue
While the HPA axis is resetting, several strategies can help support the body and mitigate fatigue. Prioritizing rest is effective, including ensuring adequate sleep quality during the initial recovery period. It is beneficial to limit strenuous physical activity and avoid heavy lifting for the first 24 to 48 hours to allow the body time to recover.
Maintaining consistent hydration supports overall metabolic function and helps the body clear the synthetic steroid more efficiently. Dietary choices also play a role, as the steroid can temporarily affect blood sugar levels. Consuming a balanced diet rich in lean proteins and complex carbohydrates, while avoiding high-sugar foods, contributes to stable energy levels.
When to Consult a Healthcare Provider
It is important to distinguish common, temporary fatigue from symptoms that may signal a more serious issue requiring medical attention. Contact a healthcare provider if the fatigue is debilitating or persists significantly longer than the typical maximum timeline of two weeks. Any signs of infection at the injection site, such as increasing pain, severe redness, swelling, or warmth, warrant immediate consultation.
A consultation is also necessary if the fatigue is accompanied by systemic symptoms like a persistent high temperature or chills, which could indicate an infection elsewhere. Other red flags include experiencing severe dizziness or noticing signs of significant blood sugar changes, such as excessive thirst, frequent urination, or a fruity odor to the breath. These symptoms may suggest complications that require prompt evaluation.