PRP vs. Cortisone Shots: Long-Term Benefits, Side Effects
You're in pain. Your doctor suggests an injection. But suddenly you're faced with a choice that could affect your health for years to come. Cortisone or PRP. The quick fix or the healing solution. The temporary relief or the long-term repair.
This isn't just about immediate pain relief anymore. Recent research has fundamentally changed what we know about these treatments, revealing that cortisone provides immediate but temporary relief, while PRP encourages long-term healing and regeneration with benefits lasting up to a year or more.
The Bottom Line Upfront: If you want instant relief and don't mind repeating treatments every few months, cortisone works brilliantly short-term. If you want actual healing that addresses the root cause of your pain and lasts substantially longer, PRP is proving superior according to the latest clinical evidence.
What Actually Happens Inside Your Body
Cortisone's Quick but Costly Relief
Cortisone injections are derived from corticosteroids that grew popular due to potent anti-inflammatory properties and instant pain relief. Think of cortisone as a powerful anti-inflammatory sledgehammer that immediately silences pain signals.
But here's what your doctor might not emphasise: cortisone can mask the pain but does not heal the damaged tissue and has long-term side effects, such as deterioration of the tissue. Multiple cortisone shots can actually weaken tendons over time, increasing rupture risk.
A recent systematic review published in 2023 found that corticosteroids have better efficacy in short term, whereas PRP is more beneficial for long-term recovery. The research showed cortisone peaked at 6-8 weeks before symptoms returned, often worse than before.
PRP's Slower but Lasting Transformation
PRP encourages a controlled inflammatory response to stimulate tissue repair, with patients often reporting noticeable improvements within a few weeks, with results continuing to improve over several months.
Unlike cortisone's suppression approach, PRP works by delivering concentrated growth factors directly to damaged tissue. PRP injections aim to deliver a large number of platelets to injured tissues to bolster the healing process, with platelets being a natural source of growth factors required for tissue healing and regeneration.
Recent clinical studies show impressive results. A study conducted by Tanpowpong et al. found that PRP offers significant advantages over cortisone, particularly when it comes to reducing tear size and improving function in rotator cuff tears.
The Science Speaks: Head-to-Head Comparisons
Tennis Elbow Research Revolution
The most compelling evidence comes from tennis elbow studies. A systematic review found that corticosteroid injections provided rapid symptomatic improvement with maximum effect at 6-8 weeks before symptoms recurrence, whereas PRP showed slower ongoing improvements up to 24-52-104 weeks in three studies.
This isn't just about duration. The research revealed something concerning about repeated cortisone use: reduced tendon thickness and more patients with cortical erosion were noted in the corticosteroid group, whereas increased tendon thickness and fewer common extensor tendon tears were noted in the PRP group.
Rotator Cuff Breakthrough Studies
For shoulder injuries, the evidence is equally striking. Nine studies with 469 patients showed that in short-term treatment, corticosteroids were superior to PRP, but no statistically significant difference was observed between the two groups at midterm, and PRP treatment was significantly better than corticosteroid treatment in the long term.
The practical translation: if you need to lift your arm pain-free next week, cortisone wins. If you want your shoulder working properly in six months without repeated injections, PRP is your answer.
Real-World Patient Outcomes
A study in the Journal of Orthopaedic Surgery and Research with 40 patients split into two groups found that those receiving cortisone shots noted rapid pain relief, but pain resumed after 15 weeks. The PRP cohort reported pain improvement continuing up to 30 weeks, with only a slight uptick after a year.
The Hidden Costs of Cortisone
Tissue Deterioration Nobody Discusses
Multiple cortisone injections spaced four to six months apart often show the first injection helped significantly, but the second injection's effects wore off after just a week or two. This isn't coincidence - it's progressive tissue damage.
Research consistently shows cortisone can cause:
Tendon weakening and rupture risk
Cartilage breakdown acceleration
Bone density reduction at injection sites
Progressive tissue deterioration with repeated use
Despite significant mounting evidence that corticosteroids last only a short time and can actually worsen osteoarthritis, insurance-covered corticosteroid injections are sometimes favoured over the less risky and better long-term pain reducing PRP option.
The Insurance Paradox
Here's the frustrating reality: insurance often covers cortisone but not PRP, despite PRP being safer long-term and more cost-effective when you factor in repeated treatments and potential complications.
Why PRP Takes Longer but Lasts Longer
The Biology of Real Healing
PRP injections contain a concentration of platelets 3-5 times greater than natural plasma, and generally, the less wear and tear your joint has, the more pain relief you can expect.
Think of it this way: cortisone is like taking painkillers for a broken bone without setting it. PRP is like properly setting the bone and letting it heal stronger than before.
After a PRP injection, patients may experience some soreness or mild swelling in the treated area, which is normal healing response. Unlike cortisone injections which aim to suppress inflammation, PRP encourages controlled inflammatory response to stimulate tissue repair.
Optimal PRP Protocols
Recent research has refined PRP approaches significantly. Several studies show that multiple injections provide better pain relief compared to single injections of PRP, with recommendations for maximum results being three injections administered one week apart for three weeks.
When Each Treatment Makes Sense
Choose Cortisone If
You need immediate relief for an important event
You have acute inflammation from injury
You're managing a flare-up of chronic conditions
You understand it's temporary and are prepared for repeat treatments
Choose PRP If
You want to address the underlying tissue damage
You can tolerate gradual improvement over weeks
You want to avoid repeated injections
You're seeking lasting improvement rather than symptom masking
In situations where cortisone was not effective, this is often indicative that inflammation was not the primary problem, making PRP a more appropriate choice.
The Future of Joint Pain Treatment
Combination Approaches
Some clinicians now use strategic combinations. PRP injection administered simultaneously with hyaluronic acid injection enhances each treatment's respective effects and demonstrates significant symptom decrease compared to either injection alone.
Quality Matters Enormously
Not all PRP is created equal. The concentration, preparation method, and injection technique dramatically affect outcomes. PRP treatment quality can vary between clinics, so it's essential to choose a provider with experience in regenerative medicine who uses only the highest quality PRP.
Making Your Decision
Consider your priorities carefully:
Immediate Relief Priority Cortisone provides faster symptom relief but requires acceptance of temporary results and potential repeat treatments.
Long-term Healing Priority PRP offers superior lasting benefits with tissue regeneration but requires patience for gradual improvement.
Safety Priority PRP uses your own blood components with minimal side effects, while cortisone carries tissue deterioration risks with repeated use.
The research is clear: for lasting improvement and tissue health, PRP represents the future of injection therapy. For immediate relief when timing is critical, cortisone remains valuable short-term.
Both treatments have earned their place in modern medicine, but understanding their distinct roles helps you make the right choice for your specific situation and goals.
If you're ready to explore whether PRP could provide the lasting relief you're seeking, our specialists can assess your specific condition and discuss whether this innovative treatment approach is right for you. Message us on WhatsApp for a free consultation to discuss your options and create a personalised treatment plan.