Not many things in life cause as much frustration as chronic pain. Many people are looking for alternatives to pain medications since over-the-counter options are often inadequate and short-lived, while prescription options carry the very real risk of dependency.
Cortisone injections are often the next option. But should they be? And are they safe?
In this article, we’ll discuss what cortisone injections are, and why platelet-rich plasma (PRP) therapy may be the better option for your patients in the long term.
Cortisone, also known as corticosteroid, is a type of man-made steroid hormone that mimics the effects of cortisol, a natural hormone in your body.
Think of cortisol as your body’s built-in alarm clock. It plays a major role in regulating your stress response, commonly called the “fight or flight” response. When secreted by the adrenal glands, cortisol allows your body to react quickly to the “threat,” be it physiological or psychological. Once the stressful encounter has passed, cortisol exerts negative feedback to your brain, thereby returning to normal levels.
With such an important role, you may not be surprised to learn that a majority of the cells in your body have cortisol receptors. This means it can affect a wide variety of functions like your metabolic, cardiovascular, and cellular health.1
Cortisol is also vital to your health thanks to its immunosuppressive and anti-inflammatory qualities.2 These characteristics are what have made cortisone injections a popular option for pain relief.
The main benefits of cortisone injections are quick pain relief and increased function. And since the injections work locally, they may also help avoid the need for oral steroids, which are associated with more side effects.
As with all other kinds of injections, cortisone injections can have some side effects. Although rare, potential side effects include:3,4,5
Corticosteroid injections can also affect your body on a molecular level. In a 2020 report by Puzzitiello and colleagues, corticosteroid injections were found to decrease cellular proliferation and viability, increase cell death (apoptosis), alter collagen and extracellular matrix composition, and interfere with inflammatory pathways. These changes were seen as early as 24 hours after patients received corticosteroid injections for rotator cuff tendon repair.6
Unlike cortisone injections, which have anti-inflammatory effects, PRP induces both anti- and pro-inflammatory responses.
Pro-inflammatory? Why would anybody want more inflammation in an already inflamed joint?
The answer is simple – to fix what’s actually causing the swelling and pain.
Despite the bad rap inflammation has received in recent years, it’s a necessary, natural healing mechanism in the body. It’s only when inflammation gets out of control that it becomes a problem. In fact, one technique for eliminating inflammation is to induce it to trigger the body’s normal wound-healing process.7
The above technique can be accomplished by PRP. PRP contains growth factors and numerous anti- and pro-inflammatory and cytokines, which activate various signaling pathways in cells. A study by Hudgens and colleagues found that PRP most highly induced the pro-inflammatory TNFɑ and NFκB pathways, leading to the formation of reactive oxygen species.8 Experts believe this and other mechanisms contribute to tissue healing and regeneration.
In other words, cortisone injections are a useful bandaid when you’re experiencing severe pain, but only PRP addresses the root cause of the problem.
One systematic review compared the effects of corticosteroid and PRP injections for the management of lateral epicondylitis, also known as “tennis elbow.” From the 5 randomized clinical trials (250 patients) analyzed, the authors found that corticosteroid injections provided more rapid symptomatic improvement, with maximum effect observed at 6 to 8 weeks before symptoms returned. On the other hand, PRP showed a slower rate of improvement but its effects lasted much longer.9
In a meta-analysis of 17 trials, PRP injections provided better pain relief and functional improvement over corticosteroid injections and other conventional treatments. PRP injections were also associated with better quality of life.10
And what about arthritis? Arthritis is a painful condition common among the elderly. In a 2020 study, 40 patients with knee osteoarthritis were treated with either PRP (20 patients) or a corticosteroid (20 patients). Both treatments were effective in relieving pain and improving knee function. But for patients who received a corticosteroid injection, the benefits seemed to disappear after 15 weeks. Those who received PRP treatment showed sustained improvement in pain relief up to 30 weeks, with a small increase in pain at the 1-year follow-up visit.11 This study clearly demonstrates the superiority of PRP over corticosteroid injections.
If you’d like to offer an alternative to corticosteroid injections to your patients with pain and injury, PRP may be the safer option you’re looking for. Because a patient’s own blood is used to prepare a PRP injection, it has a much superior safety profile compared to cortisone injections.
Your patients deserve more than a band-aid for their pain. Contact Dr. PRP today at (844) 377-7787 (DR-PRP-US) to learn more about PRP for pain relief and tissue repair.