Steroid Side Effects: What Repeated Steroid Injections and Tablets Can Do

Your knee was swollen, the pain kept you up at night, and one injection at a clinic made it feel almost normal within two days. Six months later the pain is back, and so is the advice: “take one more shot”. Or perhaps a neighbour swears by a “quick relief” powder from a roadside shop that works like magic for joint pain. Before long you are wondering why your sugar readings are higher, your face looks puffier and the pain keeps coming back.

Steroids are among the most useful medicines ever made, and in some illnesses they save lives. They also have well-known side effects, and those effects add up with repeated doses. In this guide, our pain specialists explain what steroids are, what to expect after a single injection, what repeated joint and spine injections can do, what long courses of tablets can do, how to spot hidden steroids in unregulated medicines, and the questions worth asking before you agree to another shot.

What are steroids, and why are they used for pain?

The steroids doctors use for pain are corticosteroids. They are man-made versions of cortisol, a hormone your adrenal glands make every day to control inflammation, blood sugar, blood pressure and your response to stress. They are not the same as the anabolic steroids some gym-goers misuse to build muscle.

Corticosteroids switch off inflammation quickly and strongly. That is why they are given as tablets (prednisolone, methylprednisolone, dexamethasone), as injections into a joint or tendon sheath (triamcinolone, methylprednisolone), and around the spine as an epidural steroid injection or a selective nerve root block.

Let us be clear: steroids are not “bad medicine”. In a severe asthma attack, a flare of rheumatoid arthritis, some kidney and skin diseases, certain muscle illnesses such as myositis, and many other conditions, they can be essential, and the benefit clearly outweighs the risk. The question is different for everyday mechanical pain such as a worn knee, a sore shoulder or a back strain. There, steroids reduce inflammation for a while, but they do not repair the tissue, so the pain often returns and the doses start to pile up.

What can happen in the days after a steroid injection?

Even a steroid injected into a joint or near the spine does not stay there. Some of it is absorbed into the bloodstream and acts on the whole body for days. Most of these short-term effects settle on their own, but you should know about them:

• Raised blood sugar. Readings can climb for a few days, sometimes longer. If you live with diabetes, check your sugars more often and tell your diabetes doctor before the injection. Our guide to back pain treatment for people with diabetes explains why this matters so much.
• Facial flushing. A red, warm face and chest for a day or two is common, especially in women. It is harmless but can be alarming.
• Sleep upset and mood change. Some people feel wired, restless, irritable or unusually low for a few nights.
• Raised blood pressure and some fluid retention, particularly in people who already have high BP.
• A temporary pain flare. The injected area can become more painful for a day or two before it improves. This “steroid flare” is usually a reaction to the crystals in the injection.
• Changes to periods or spotting in some women, and a short dip in the body’s own cortisol production.

Increasing redness, heat and swelling that get worse rather than better after two days, especially with fever, is not a normal flare. That needs to be seen the same day.

What can repeated injections do to a joint or tendon?

A single well-placed injection rarely causes lasting local harm. The problems tend to appear when the same area is injected again and again over months or years.

Tendon weakening and rupture

Steroids slow the repair of collagen, the main building block of tendons. Repeated shots into or around a tendon can leave it weaker, and in some cases it tears. This is a particular concern with tennis elbow, rotator cuff tendinitis, the Achilles tendon and the heel. Rupture of the plantar fascia has been reported after repeated injections for plantar fasciitis. In tennis elbow, studies have also found that people who get a steroid shot often feel better quickly but are more likely to relapse in the following months than those treated with exercise.

Fat atrophy and skin lightening

When steroid settles under the skin, it can shrink the fat beneath it, leaving a small dent, and it can lighten the skin into a pale patch. On Indian skin this lightening is often quite noticeable. It is most common after shots for trigger finger, De Quervain’s thumb pain, tennis elbow and trochanteric bursitis, where the tissue is thin. These changes may slowly improve, but sometimes they remain.

Cartilage concerns in the knee

For knee osteoarthritis, a steroid injection can ease a painful, swollen flare for a few weeks. However, a well-known trial that gave knee injections every three months for two years found slightly more cartilage loss in the injected group and no better pain relief over that period than a dummy injection. Other studies have raised similar concerns about frequent injections hastening joint wear. If your knee has needed shot after shot, it may be worth understanding what grade of knee arthritis you actually have and whether a different plan makes more sense.

Joint infection

Any needle into a joint carries a small risk of infection, and steroids also damp down the body’s local defences. The risk is low with proper sterile technique, but it rises in people with diabetes, those on other immune-lowering medicines, and when injections are given in non-sterile settings.

How many steroid injections a year is safe?

There is no single number that suits everyone. Many doctors follow a common rule of thumb: no more than about three or four injections into the same joint in a year, spaced several weeks to months apart, and fewer if each shot helps for only a short time. Spine injections are usually limited in a similar way, because the total steroid dose across your whole body is what drives bone and hormone effects. If you have been given injections at different clinics, add them all up. Your bones and blood sugar do not know which doctor gave the shot.

What can long courses of steroid tablets or repeated injections do to the body?

Systemic side effects depend on the dose and, above all, on how long and how often steroids are taken. They are most likely with tablets taken for weeks to months, but frequent injections add to the same total.

• Bone thinning. Steroids are the most common medicine-related cause of osteoporosis. Bone loss is fastest in the first few months of a long course, and it can lead to spine compression fractures from a minor fall or even lifting a bucket. Weak bones also slow fracture healing.
• Avascular necrosis of the hip. Steroids are a well-known risk factor for loss of blood supply to the ball of the hip, which then collapses. It usually starts as a deep groin ache. Read the early signs in our guide to avascular necrosis of the hip.
• Adrenal suppression. When you take steroids for weeks, your adrenal glands stop making their own cortisol. Stopping suddenly can then cause severe weakness, vomiting, low blood pressure and collapse (adrenal crisis).
• Weight gain and body changes. Increased appetite, a rounded “moon” face, fat around the belly and upper back, thin skin and easy bruising. Extra weight then loads the knees and back, feeding the very pain you were treating.
• Raised blood sugar and blood pressure that can persist, and in some people new-onset diabetes.
• Eye problems. Cataract (clouding of the lens) and raised eye pressure (glaucoma) with long-term use.
• Infection risk. Steroids lower immunity, so chest infections, fungal infections and reactivation of tuberculosis are more likely. TB is common in India, including spinal TB, so doctors take this seriously.
• Stomach problems. Acidity and a higher risk of ulcers and bleeding, especially when steroids are combined with common painkillers such as diclofenac or ibuprofen.
• Muscle weakness, mood changes and poor sleep. Thigh and hip muscles can weaken, making it hard to climb stairs or get up from a squat. Poor sleep in turn makes pain feel worse.

Short-term, local and long-term steroid side effects at a glance

Can “quick relief” pain powders and tablets contain hidden steroids?

Sadly, yes. In India, some unregulated pain powders, loose “joint pain” tablets, and products sold as herbal or traditional remedies have been found to contain steroids such as dexamethasone or betamethasone, often along with painkillers, without saying so on the label. They work dramatically fast, which is exactly why they are popular. Patients sometimes take them for months, believing they are natural, and arrive with a puffy face, high sugars, thin bones or a damaged hip.

• Be suspicious of any remedy that gives near-instant relief from long-standing joint pain, has no clear ingredient list, or comes in an unmarked paper packet.
• Read the label for words such as dexamethasone, betamethasone, prednisolone, methylprednisolone or “corticosteroid”.
• Show the packet or powder to your doctor. Bring everything you take, including “desi” medicines, to your appointment.
• Do not stop abruptly if you have been taking such a product daily for weeks. It may contain a steroid, and sudden stopping can make you unwell. See a doctor first so the dose can be reduced safely if needed.

Can I stop my steroid tablets on my own?

No. If a doctor has prescribed steroid tablets for asthma, an autoimmune condition, a kidney or skin disease or anything else, keep taking them as advised. Stopping suddenly after more than a few weeks can trigger adrenal crisis or a severe flare of the original illness. If you are worried about side effects, speak to the prescribing doctor. Often the dose can be lowered gradually, a steroid-sparing medicine can be added, or bone-protecting treatment can be started alongside. Tell any doctor, dentist or surgeon who treats you that you are on steroids, especially before an operation or if you fall ill with vomiting.

What should I ask before a steroid injection?

A good doctor will welcome these questions. If the answers are vague, a second opinion before injections is reasonable.

1. What exactly is causing my pain, and how will this injection treat that cause rather than only the inflammation?
2. Which medicine and what dose are you injecting? Is it a steroid?
3. How many injections have I had in this area and elsewhere this year, and what is the limit?
4. What happens to my sugar, BP or bones, given my diabetes, thin bones or other conditions?
5. What else will we do so the pain does not simply return: exercise, weight, nutrition, posture?
6. Are there non-steroid options, such as rehabilitation, gel (hyaluronic acid) injections, PRP or other regenerative medicine, and what does the evidence say for my problem?

How Dr Heal treats pain without steroids

Many people come to us after their third, fifth or tenth steroid shot, tired of relief that lasts a few weeks. Our approach is built around finding why the pain keeps coming back:

1. Find the real source. A detailed history (including every past injection and medicine), a hands-on examination, and scans read alongside your symptoms. Our in-house laboratory and radiology at our facilities let us check sugar, bone health and inflammation markers in one visit.
2. Inject only when it helps, and never with steroids. When an injection is the right tool, we use a regenerative preparation developed by Dr Heal Pharma that contains no steroid, painkiller or antibiotic. Rather than simply switching inflammation off, it is meant to support the tissue as it repairs, which is gentler on your sugar levels and bones.
3. Repair the body’s foundations. Through functional medicine and clinical nutrition, we work on blood sugar, weight, thyroid, sleep and vitamin D and B12 levels, which matter even more if steroids have already thinned your bones.
4. Strengthen what was weakened. A guided rehabilitation programme rebuilds the muscles and tendons that support the painful joint or spine.
5. Stay with you until you move freely. Regular follow-up, with the plan adjusted as you improve, and honest advice if surgery is ever truly needed.

We use this approach across our knee osteoarthritis treatment, shoulder and elbow pain treatment (including frozen shoulder), hip pain treatment, back pain treatment and joint pain and arthritis care. You can also meet our pain specialists.

What you can do to protect yourself

• Keep an injection diary. Note the date, site, clinic and medicine name for every shot.
• Check sugars and BP more often for a week after any steroid injection if you have diabetes or hypertension.
• Protect your bones with daily walking, sunlight, enough protein and calcium, and ask about a bone density scan if you have had long courses of steroids.
• Avoid unlabelled remedies and never share prescription steroid tablets with family members.
• Rest a freshly injected tendon for a short while and avoid heavy lifting or sudden sport for the period your doctor advises.

Frequently asked questions

How long does a steroid injection stay in the body?

It depends on the medicine. Effects on blood sugar and sleep usually fade within a few days to a week or two, while the effect on your own cortisol production can last a few weeks after some long-acting injections.

Is one steroid injection dangerous?

For most people, a single injection given properly is safe, with short-lived side effects. The concern grows with repeated injections in the same area and with the total amount of steroid over months and years.

Why does my pain come back after a steroid shot?

Steroids calm inflammation but do not heal worn cartilage, a weak tendon or a stiff spine. If the underlying cause, such as weak muscles, extra weight or poor joint mechanics, is not addressed, pain often returns once the steroid wears off.

Do epidural and nerve root injections also cause steroid side effects?

Yes. Steroid given around the spine is absorbed into the blood, so it can raise sugar, affect sleep and add to your total steroid exposure for bones, just like joint injections.

I have been taking a pain powder for months. What should I do?

Do not stop it suddenly. Bring the packet to a doctor, who can check for signs of steroid use, test your sugar and bone health, and, if needed, reduce it safely while treating the cause of your pain.

Where can I get steroid-free pain treatment in Bengaluru?

Dr Heal Pain Cure Hospital treats joint, spine and tendon pain without steroids at its HSR Layout and Banashankari branches. Both are open 24 hours, and patients come to us from all over Karnataka.

This article is for general information and is not a substitute for a medical consultation. Do not stop or change any prescribed medicine without speaking to your doctor.