SI Joint Injections, Part 2: Lidocaine and Cortisone Together

Hi everyone!

In my last post, I talked about cortisone injections for the SI joints.  This type of injection is what many doctors who treat the SI joint consider to be the “gold standard” for diagnosing SI joint problems.

In this post, I wanted to talk about the other major type of injection a doctor might offer you– an injection of lidocaine and cortisone, combined.  Then I’ll be following up with a discussion of risks and benefits of both types of injections.

Lidocaine, as I mentioned previously, is a numbing chemical that temporarily blocks out pain in the area it’s injected in.

Cortisone, on the other hand, is a powerful steroid that can be used to cut down the inflammatory process, so that an injured joint has a chance to calm down and heal.

While a doctor might offer you lidocaine alone, a cortisone injection will always be accompanied by lidocaine, because… why not?  You’re already sending a needle in there, and the injection itself is going to cause pain.  So the lidocaine is to give you immediate, temporary relief, while the cortisone can take 2-3 days to start working.

The purpose of cortisone:

Basically, your body starts the process of inflammation in order to heal an injured joint.  It sends lots of white blood cells and special chemicals to an area to facilitate the repair of damaged tissues.

However, although you need inflammation in order to heal (I’m SO tired of articles that make it sound as though any inflammation at all is bad) at some point, the cycle can become self-perpetuating.

Those same chemicals in the joint that tell your body to send that initial, healing inflammation don’t always know when to stop working.  So your body keeps sending extra supplies and fluid, and in the long run, this can actually create more pain and keep the joint irritated.

It’s like so many things in the body… what starts out as a good and necessary process can sometimes become counterproductive, if it goes on for too long.

So the purpose of cortisone (or the other steroids doctors sometimes prescribe) is to come in and put slow the stream of new inflammation coming in to the area.   This allows your body to sort of take a breath and sort out what really needs to happen in the joint.

It can then drain and remove some of the old, used-up inflammatory chemicals that are now just sitting there, because they got kind of stuck when new chemicals were constantly coming in.

So when you have a joint that’s been chronically painful for a few weeks, or a few months, sometimes cortisone is a good way to “reset” things and help your body calm down.

The risks:

Unfortunately, there are risks to both of these types of injections.

Physical risks:

It’s unlikely, but any time you’re sticking a needle in to the body, you do risk infection, or causing injury to a nerve or other tissues.   (Check out this Mayo Clinic article for more).

Chemical:

For cortisone injections only– there is sometimes a risk that using a steroid like cortisone can backfire, and make your surrounding tissues (tendon and bone) weaker.  Again, I’m not a doctor, but in my understanding as a patient, these risks are low if you’re a young(ish) and relatively healthy person.  It’s more of a risk in an elderly person, or someone who has had many repeated injections over the years.

As the Mayo Clinic article explains, these risks are why doctors generally won’t give a patient more than 3-4 cortisone injections in one year.

I never received any type of injections in my SI joints, but I did once receive a combined lidocaine and cortisone injection in my knee.  (This was back in 2011 when I was dealing with chrondromalacia patella, a condition involving inflammation under the kneecap).

My orthopedist did discuss the risks of cortisone with me.  Basically, she explained that “these risks are really only something we worry about in an elderly person who comes in for multiple injections in a year, and has been dealing with a chronic condition like arthritis for years.”  Based on my discussion with her, I came to feel that the risks for someone like me were relatively low.

The pain of having extra fluid injected in an area that’s already inflamed:

The truth is that I personally did come to regret having my injection for a different reason.  It turns out that sometimes, the physical act of injecting fluid into an area that’s already inflamed can cause even more pain.

When I had the injection in my knee, I was instantly in more pain.  I couldn’t put my full weight on my leg.  I had driven myself to the office and walked in, but it hurt too much to walk out, and to drive myself home (since it was my right knee).  I had to call my mom to come and get me, and they gave me crutches to get down to the parking lot.

I don’t want to scare anyone– maybe a cortisone injection is exactly what you need for healing.  But in my case, my knee was already so inflamed that putting any extra fluid in there at all just was not a good idea.

If you are contemplating having cortisone or lidocaine injections, I’d make sure you have a very thorough discussion of the risks with your doctor, and also mention that you’d heard people can sometimes react this way, just to the extra fluid.

In all my emailing with readers (I’ve probably heard the various stories of about 75 different SIJD sufferers at this point) I’ve only heard of one other person who had this sort of physical reaction to extra fluid in her SI joints.  So it’s rare, but it is possible.

So, my bad experience with having a cortisone injection in my knee is part of why I decided not to have one for my SI joints.

However, there’s another major reason why I personally chose not to:

Neither I nor the doctor I saw really seemed confident that an injection would actually help me.

This post is getting a bit long, so I’ll be explaining why in my next post!  Stay tuned!

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