DEAR READER: Cortisone can be injected into joints such as the ankle, knee, shoulder and other areas to relieve pain and inflammation. They have been known to help osteoarthritis, gout, carpal-tunnel syndrome, bursitis, plantar fasciitis and a host of other conditions. About 30 years ago, corticosteroids were given with great regularity. Today, however, a different approach is taken. Some physicians restrict a person to three injections a year, others to three in a lifetime. This has resulted from research indicating that repeated injections can cause damage to tissues over time when given in excess quantities to one area of the body. One consideration is whether or not the injections work. If one or two are unsuccessful for reducing pain, it’s rather unlikely that additional ones will respond any differently.

Side effects include a cortisone flare, in which the injected material crystallizes, causing pain for up to two days that could be greater than what was experienced prior to the injection. Tendons can be weakened, there can be pain at the injection site, and the color of the skin at the site can change. The most common systemic reaction is observed in diabetic patients, who should monitor their readings, because cortisone can cause a rise in blood-sugar levels. Long-term risks of high doses with frequent administration can include weight gain, facial puffiness, cataracts, osteoporosis, hypertension and rare but serious damage to the large joint bones, known as avascular necrosis.

So, in answer to your question, your mother should return to her orthopedic surgeon or the physician who gave her the injections. If that specialist (who is familiar with her medical history) feels strongly that no more should be administered, then I suggest you heed the warning. If, however, your mother is aging, her quality of life is affected, and she cannot find relief from pain through other means, perhaps she will receive a favorable response. The pros and cons can be answered only by the person behind the needle.

To provide related information, I am sending you a copy of my Health Report “Osteoporosis.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title.

I am most uncomfortable when I stand still, sit or lie down for any length of time. Using a heating pad several times during the night helps alleviate the muscle cramping, though. I have more pain in my lower back/sacral area, knees and thigh muscles than in the hips themselves. Who is right? Would the cortisone injections really help?

DEAR READER: I must side with the out-of-state specialist. Cortisone injections are often beneficial as one of the initial steps toward relieving the pain of arthritis. A randomized placebo-controlled trial of glucocorticoid injections for osteoarthritis of the hip demonstrated benefits lasting up to three months. Over-the-counter medications such as acetaminophen, ibuprofen or naproxen, topical capsaicin or menthol ointments (especially those made with castor oil), and ice packs or heat may also provide relief. If these options fail to provide satisfactory results, consider physical therapy, low-impact exercise programs or enter a chronic-pain class to learn other ways to manage the pain. A final option for those with severe joint deformity, pain and dysfunction is surgery, such as joint realignment or replacement.
Seek out another local specialist or return to the out-of-state physician for further advice and treatment.

To provide related information, I am sending you a copy of my Health Report “Understanding Osteoarthritis.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.