Why can’t cortisone shots be used instead of taking prednisone

Posted by monigue @monigue, 6 days ago

After being sick with bronchitis, last year, and being treated with antibiotics , after a month suddenly over night I experienced shoulders and hip/ girdle pain !!
It was so severe that I couldn’t stand up and sit down without help.
Visited a rheumatologist, and my condition was described as PMR. (polymyalgia arthritica ) ( never heard of it ) .
The oral prednisone was prescribed. But I was hesitant to take it due to some concurrent medical problem ( afib, past eye macular hole and breast cancer surgery , etc,). I have looked at the list of prednisone side effect, including might be worsened conditions, I mentioned.!!
So, I decided to go for periodical cortisone shots, ( one join at the time -left than right shoulder, than left hip)!
The pain subsides , but returns in 2-3 weeks. A pain clinic’s doctor don’t suggest and don’t coordinate the shots more often than between one-two month !!!
Why? Isn’t better than having prednisone permanently in the system when taking orally every day !! Plus to be a “dog watch” having prednisone tampering back and forth . And still not is being sure that disease is treated.
Wander if somebody have different thoughts , and approaches to the pain.
Thank you

Interested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) Support Group.

jabrown0407 | @jabrown0407 | 6 days ago

I avoided prednisone for a year or so, for various reasons and received steroid hip and shoulder injections. They did relieve the pain for a short time. Injections are not systemic, but PMR is. Injections have their own side effects, like damage to the joints involved this should not be discounted. I understand not wanting to start oral steroids.

I would talk to the doctors who are focused on your current issues to find out what problems steroids at say 10mg/day might cause. Then make a decision that best serves your needs. Please remain open to change your perspective.

I have had to be on prednisone multiple times in 6+ years. I normally start at 20mg to gain control of the pain. I move to 15mg as soon as the pain is gone, and then down to 10mg if the pain remains gone for 5 days at 15mg. I most often get to 10mg within 10-12 days. Just to give you an idea of what is "normal" for me.

kjoed53 | @kjoed53 | 5 days ago

It took five months for me to get my PMR diagnosis. Initially it was thought that I had a pinched nerve in my neck because of my cervical spine issues. I received cortisone shots three times but they only lasted two weeks before the pain came back with a vengeance. PMR is a diagnosis of exclusion. It's the last option after ruling out the others. I don't like being on the prednisone but it's a necessary evil to control the pain enough to function. By the time I was diagnosed, I was experiencing girdle pain that never subsided. I couldn't sleep, walk or even sit without excruciating pain that ibuprofen couldn't even temper. I had to use a cane to get around and standing up or sitting down became a new adventure in pain every time. Once I got on 25mg prednisone I was able to lose the cane and resume a somewhat normal life. I'm now tapering down the prednisone because I also have SMM and prednisone masks the blood work used to diagnose and determine the path for treatment. I have no choice but to balance the two different diagnoses. I'll be discussing LDN with both my rheumatologist and hematologist oncologist if my PMR pain returns to pre prednisone levels.

Mike | @dadcue | 4 days ago

Cortisone shots can be used if your pain is "localized" but PMR is more "systemic." Oral prednisone is used for "systemic inflammation."

I have a problem with severe spinal stenosis in the lumbar spine in addition to PMR. I once had a "flare" of radicular leg pain (sciatica) which caused severe lower back pain that radiated down into my entire right leg. My radicular leg pain occurred when a spinal nerve in my lower back was pinched, compressed, and inflamed and sent pain along the nerve's path into my leg all the way to my ankle. This pain wasn't localized but it was one-sided. PMR pain is usually bilateral. I took oral Prednisone because I had to do something. I was already on Prednisone for PMR so I increased my dose significantly. I averted an emergency spinal fusion so I was pleased with my intervention.

My rheumatologist listened to my account of the whole ordeal. I explained to her how the pain went away after a 60 mg dose of Prednisone. My rheumatologist wasn't so pleased but she was happy the pain stopped. She looked at my MRI and said the spinal stenosis caused my pain. She said I shouldn't have taken so much systemic oral prednisone. She would have recommended a localized steroid injection and physical therapy.

While high-dose systemic (oral) prednisone is highly effective at reducing inflammation, it is generally discouraged for treating structural issues like spinal stenosis.

The converse is also true. Systemic oral prednisone is more suitable for the systemic inflammatory diseases like PMR.

dlb3 | @dlb3 | 4 days ago

Mike, I agree with you completely. I am in a similar position diagnosed with PMR in November 2023. Completely off of prednisone since June 2024. Polymyalgia pain daily is controlled by taking two ibuprofen.
However, the last 10 months I have been experiencing excruciating pain bilateral lower back down the buttocks and legs. For quite some time I thought this was just PMR pain. Went to orthopedic spinal doctor for balance issues, PA prescribed 10 sessions of PT. Had follow up x-ray and MRI. Diagnosed recently with degenerative disc disease and severe spinal stenosis, and vertebrae misalignment in the L4 - L5 area. discussing next possible step of “steroid injection” to alleviate the pain. Two separate issues.