Do steroid shots hurt?

Many of us will have heard of someone who had a very painful experience having a steroid injection. If I had a pound for every patient that told me that someone they knew had had a steroid injection which was reported as agonisingly painful then I would be rich!  

So, are all these people exaggerating? Or is it true that steroid injections are very painful? 

Expertise and experience counts

For many years I used to inject patients without image guidance. And although sometimes injections were painful, I do not think that they were particularly painful for most patients.  But I am very experienced musculoskeletal clinician with good anatomical knowledge and expertise. I  carried out many injections and therefore was able to perfect my technique. 

Conversely in those who lack experience and who dnot see a great volume of patients it is very possible that the combined effect of lack of skill and small numbers of injections lead to these injections being more uncomfortable when they are carried out.  

Why are unguided injections more painful?

The operator completely relies on their knowledge of the anatomy to guide the needle safely into the joint. Even for experienced injectors it is impossible to exactly know whether their needle is perfectly placed to enter the joint/ or soft tissue.

Pain sensitive structures such as bone ligaments or tendons are often touched and cause pain which depending on how hard the needle is touching these structures can be severe.

Ultrasound guided injections

For many years now I have been injecting patients under ultrasound guidance. In my opinion this has made these procedures less painful and has also improved accuracy massively.

Studies such as Sibbitt et al. (2009) have supported my personal experience. They found a 43.0% reduction in procedural pain (p < 0.001) (n=148) when comparing landmark guided to ultrasound-guided groups. VAS pain scores at 2 weeks were also 58.0% lower (p < 0.001) than in the unguided injection group. 

Other reasons why ultrasound-guided injections are generally preferred are: accuracy and safety; the operator can direct the needle away from pain sensitive structures that could potentially be damaged by the injection needle. 


To answer the question: Do steroid shots hurt? Realistically all steroid injections cause some discomfort no matter how skillful it is done. But unguided injections, even in the hands of experienced injectors,  are more painful and the research supports this (Sibbitt et al., 2009). Ultrasound-guided injections are much better tolerated. The accuracy of guiding injections allows the injection to be accurately guided thereby avoiding pain sensitive structures and cause much less discomfort.

Looking for an expertly delivered and pinpoint accurate injection?

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With thousands of successful ultrasound guided injections behind him contact our lead clinician Rob Mast for a free telephone consulation.

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