If your pain feels worse after having a steroid injection, you may understandably wonder whether something has gone wrong. In many cases, a temporary increase in pain is a recognised reaction known as a steroid flare or post-injection flare.
Steroid injections are used to reduce inflammation and pain in conditions affecting joints, tendons and soft tissues. However, the injection does not always provide immediate relief. Some people experience increased pain or tenderness for a short period before the steroid begins to take effect.
At Alton Pain Clinic, we provide ultrasound-guided injections to help accurately target the affected area. Your clinician will discuss what to expect after your injection and advise you on appropriate aftercare.
What Is a Steroid Flare?
A steroid flare is a temporary increase in pain, tenderness or swelling around the area where the injection was given.
It can occur within the first 24 to 48 hours after a steroid injection and usually settles over the following few days. Some NHS guidance notes that a flare can occasionally last for several days longer.
A steroid flare does not necessarily mean that the injection has failed. The steroid may simply need more time to produce its anti-inflammatory effect.
Why Can Pain Get Worse After a Steroid Injection?
There are several possible reasons why your pain may temporarily increase.
1. A temporary local reaction
The tissues around the injection site can react to the medication, causing temporary inflammation, tenderness or swelling. This can make the treated area feel more painful before symptoms begin to settle.
This reaction is generally short-lived and is one of the recognised side effects of corticosteroid injections.
2. The local anaesthetic has worn off
Some steroid injections are given alongside a local anaesthetic. This can provide temporary numbness or pain relief immediately after the procedure.
As the local anaesthetic wears off, your original pain may return. This can make it feel as though your symptoms have suddenly become worse, even though the steroid has not necessarily had enough time to work.
3. The steroid takes time to work
Steroid injections are not always an instant treatment for pain. Depending on the injection and the condition being treated, it can take several days for the anti-inflammatory effect to become noticeable. Some injections may take longer to reach their full effect.
This means that experiencing pain shortly after an injection does not automatically indicate that the treatment has been unsuccessful.
4. The injection site may be temporarily sore
It is normal for the area around the injection to feel tender or bruised for a short period. The needle passes through the skin and soft tissues before reaching the intended treatment area, which can contribute to temporary discomfort.
How Long Does Pain Last After a Steroid Injection?
For most people who experience a steroid flare, the increase in pain is temporary.
Pain may become worse during the first 24 to 48 hours and usually begins to settle over the following few days. The exact duration can vary depending on the individual, the injection site and the condition being treated.
If your pain is severe, continues to worsen, or does not begin to settle as expected, contact your clinician for advice.
What Can I Do If My Pain Is Worse After a Steroid Injection?
Your clinician will give you specific aftercare advice based on the area treated and your individual circumstances. General measures may include:
- Rest the treated area and avoid strenuous activity immediately after the injection.
- Avoid putting excessive strain on the treated joint or soft tissue while it is sore.
- Use an ice pack if advised, particularly if there is temporary swelling or tenderness.
- Take appropriate pain relief if it is safe for you and recommended by your clinician.
- Gradually return to normal activity according to the advice provided after your injection.
Do not assume that increasing your activity because the area initially feels numb or pain-free is appropriate. If a local anaesthetic was used, its effects may wear off before the steroid has started providing its full anti-inflammatory effect.
When Should I Be Concerned About Pain After a Steroid Injection?
A temporary steroid flare is usually self-limiting. However, worsening symptoms can occasionally indicate a complication that needs medical assessment.
Contact your clinician promptly if you develop:
- Severe or progressively worsening pain
- Increasing redness, warmth or swelling around the injection site
- A high temperature or chills
- Feeling generally unwell
- Discharge from the injection site
- Symptoms that are not improving as expected
An infection following an injection is uncommon, but it is important to seek medical advice if you develop symptoms that could indicate infection.
If you experience severe symptoms or feel seriously unwell, seek urgent medical attention.
Does Increased Pain Mean My Steroid Injection Has Not Worked?
Not necessarily.
A temporary increase in pain during the first few days can occur even when the injection subsequently provides relief. The steroid needs time to exert its anti-inflammatory effect, and the response varies between individuals and conditions.
However, steroid injections do not work for everyone. If your symptoms continue or return, your clinician can review your response to treatment and discuss whether further management is appropriate.
Why Choose Ultrasound-Guided Steroid Injections?
At Alton Pain Clinic, steroid injections can be performed using ultrasound guidance.
Ultrasound allows the clinician to see the relevant anatomy in real time and guide the needle towards the intended treatment area. This can be particularly useful when treating specific joints, tendons, bursae and other soft tissues.
The aim is to deliver the injection accurately to the area identified during your assessment.
Your clinician will first assess your symptoms and determine whether a steroid injection is an appropriate treatment option for you.
What Should I Expect After a Steroid Injection?
Everyone responds differently, but you may experience:
| After your injection | What you may notice |
|---|---|
| Immediately afterwards | Some tenderness, numbness or temporary pain relief if local anaesthetic was used |
| First 24–48 hours | Possible increase in pain or a steroid flare |
| Following few days | The flare should generally begin to settle |
| Following days to weeks | The steroid’s anti-inflammatory effect may become more noticeable |
Your individual recovery may differ depending on the area treated and the underlying condition.
Steroid Injection Pain: The Key Takeaway
A temporary increase in pain after a steroid injection can be unsettling, but it is often a short-lived steroid flare rather than a sign that something has gone wrong.
Give the treated area time to settle, follow your clinician’s aftercare instructions and monitor your symptoms. If pain becomes severe, continues to worsen, or is accompanied by redness, warmth, swelling, fever or feeling unwell, seek medical advice.
At Alton Pain Clinic, our clinicians assess your symptoms and treatment needs before recommending an injection. Where appropriate, ultrasound-guided steroid injections can be used to accurately target the affected area as part of an individualised pain management plan.
This article is intended for informational purposes only and should not replace professional medical advice. If you are experiencing persistent symptoms, please consult a qualified clinician.
Frequently Asked Questions
Is it normal for pain to be worse after a steroid injection?
Yes. Some people experience a temporary increase in pain, known as a steroid flare. It commonly occurs during the first 24 to 48 hours and usually settles within a few days.
How long should pain last after a steroid injection?
A temporary flare usually settles within a few days, although the duration varies between individuals. If pain is severe, continues to worsen or is not settling, contact your clinician.
Should I rest after a steroid injection?
You may be advised to rest the treated area and avoid strenuous activity for a period after the injection. The exact advice depends on what has been treated, so follow the instructions provided by your clinician.
Can a steroid injection make pain permanently worse?
A temporary increase in pain is recognised after steroid injections. Persistent or worsening pain should be assessed by a clinician rather than assumed to be a normal steroid flare.