A cortisone injection involves delivering a corticosteroid medication, a potent anti-inflammatory drug, directly into a joint or soft tissue structure. The primary goal is to significantly reduce inflammation and provide long-term pain relief for conditions like arthritis or tendonitis. Although the injection is designed to soothe the area, a temporary side effect known as a “cortisone flare” may occur shortly after the procedure. This common, localized reaction results in a temporary increase in discomfort before the true pain relief begins. It is a response to the medication itself and is not a true allergic reaction or a sign of infection.
Describing the Cortisone Flare Sensation
The experience of a cortisone flare is characterized by a significant, localized increase in pain, often more intense than the original condition being treated. This discomfort typically begins within a few hours of the injection, as the local anesthetic starts to wear off. The sensation is strictly confined to the injection site and surrounding tissues.
Patients often describe the pain as a sharp, aching, or burning feeling deep within the joint or soft tissue. Accompanying this increased pain are localized physical signs, including noticeable swelling, warmth, and mild redness at the injection site.
The intensity of the pain can be surprising, leading many people to worry that the injection has failed. However, this localized reaction is essentially an inflammatory response the body generates around the injected medication before the powerful anti-inflammatory effects can take hold.
The Biological Mechanism Behind the Flare
The mechanism producing the cortisone flare relates directly to the physical form of the medication used in the injection. Corticosteroids are often formulated as a suspension of microcrystals to allow for a slow, sustained release of the drug over an extended period. This crystalline structure enables the long-lasting anti-inflammatory benefit of the injection.
Before dissolving, these tiny, insoluble steroid microcrystals act as a temporary irritant within the joint capsule or soft tissue. The body’s immune system recognizes these physical particles, triggering a localized inflammatory response in an attempt to clear the foreign material. Immune cells, particularly macrophages, may collect around the crystals, initiating temporary inflammation.
This localized immune reaction causes the symptoms of pain and swelling. It is a sterile inflammation, meaning it is caused by the physical presence of the crystals, not by bacteria or infection. Once the body absorbs or processes these microcrystals, the inflammatory reaction subsides, and the primary anti-inflammatory action of the steroid begins.
Expected Duration and Symptom Management
A cortisone flare is a short-lived event, typically beginning within a few hours of the injection and resolving on its own. Most people find that the peak discomfort occurs within the first 24 hours, with symptoms completely subsiding within 48 to 72 hours. If the pain and swelling continue to worsen or persist beyond three days, a healthcare provider should be contacted.
Managing the symptoms during this brief period focuses on simple, at-home care techniques. Applying a cold compress or ice pack to the injection site for 15 to 20 minutes several times a day can help reduce the localized swelling and numb the pain. It is also important to rest the injected joint and avoid strenuous activity for the first day or two.
Over-the-counter pain relievers such as acetaminophen or ibuprofen may be used to manage the discomfort, provided they are not contraindicated by other health conditions. Monitor the injection site for signs that differentiate a temporary flare from a more serious complication. A true infection, though rare, is characterized by symptoms that spread beyond the injection site, such as a high fever, worsening redness, or the presence of drainage or pus.