Cortisone Controversy

Understanding how the body works to heal and repair itself is critical information when it comes to understanding the effects of medications such as cortisone. Since injections of cortisone are so frequently used for foot and ankle pain, it is important to arm yourself with certain facts about the drug and how it affects the human body.

Before we get into the specific effects of cortisone, you will need to learn a little about what inflammation really is and what it’s purpose is. Although we think of inflammation as something bad and something to be suppressed, it, in fact, is an essential function mediated by the immune system.

For purposes of clarity and ease of understanding, we will talk about 2 pathways of inflammation commonly utilized by our bodies. Whenever there is a particular problem in our body that involves either a functional or metabolic stress, there will always be an increased rate of cellular respiration in the area. In other words, the cells of the area under stress will speed up their rate of metabolism. This causes the area to create more toxic by-products of metabolism than would usually be found in the area under normal circumstances. These are toxins that must be neutralized and eliminated by the body to prevent cellular damage in the area. This is where the first pathway of inflammation comes in.

The first pathway, or primary inflammation, is a pathway that is involved with detoxification and repair. This pathway will address the build-up of toxins. Once the area is detoxified, the repair of all injured tissues in the area takes place. When the primary pathway of inflammation is efficient, we will not be aware of any symptoms of pain, swelling, redness or heat in the area. In other words, we don’t feel this pathway at work. This pathway is utilized either in the early stages of a problem, or ongoing when it remains efficient and effective at managing the stress in the area.

There are various reasons why the primary pathway of inflammation may prove inefficient. The first is a compromised immune system, which is unable to drive the necessary detoxification and repair pathway. The second reason is that the level of functional or metabolic stress in the area is beyond the capabilities of the primary pathway. When this happens, there will be an added level of toxification of the tissues (areas under this type of stress serve as free-radical magnets, free radicals being electrically unstable compounds that are responsible for attacking and damaging our cells). A higher degree of tissue damage may then ensue. This is where the secondary pathway of inflammation steps in.

Secondary inflammation, or what you may know as chronic inflammation, is the pathway that takes over when the primary pathway fails to manage the problem. This pathway is not a pathway of detoxification and repair, but rather it is a pathway of protection. Cells of the area are protected from rapid destruction by this pathway and it also works to allow the tissues to adapt and compensate for the ongoing problem. Although this is a degenerative pathway, secondary inflammation prevents the tissue assault from spiraling out of control.

Now that you understand the purpose of inflammation, we can discuss cortisone as a medical intervention for inflammatory problems. Of course, cortisone has as its major application in medicine, the ability to suppress inflammation. It does so by blocking the ability of the immune system to address the problem in a manner that we have just discussed. This might seem good on the surface because inflammation produces pain and cortisone has the ability to suppress the pain-causing inflammation. But remember what we said about inflammation, it is designed for 3 main purposes; detoxification, repair and protection. Therefore we are, in fact, suppressing the body’s ability to detoxify, repair and protect. Empirically then, we see that this approach leaves the body wide open for other problems when these pathways are crippled. And, it is well known in medicine, that areas that have been repeatedly injected with cortisone suffer from accelerated damage over time.

The second thing we must be aware of is that any time a drug is used as a blocking agent (e.g. a blocker of inflammation), we know we will encounter side-effects. In other words, if we put up a roadblock to a natural bodily function, then the body will undergo a physiologic compensation in an attempt to “go around” the roadblock. Some of the unwanted effects of cortisone also put the body in danger of further injury and add a level of chronicity to the situation. One of these side effects is cortisone’s capacity to damage connective tissue. It does this in two ways. The first is that cortisone is fibrolytic, which means it is capable of breaking down fibrous connective tissues, the very tissues that support our joints, ligaments, tendons and joint capsules. This certainly does not make much sense if these are the very tissues we are attempting to treat with the cortisone injection. Additionally, as we said before, if the body is unable to repair the involved tissue, it will ultimately compound the problem. Other side effects such as water retention, elevated blood sugar, suppression of the adrenal glands and the immune system, loss of bone calcium, increased susceptibility to bacterial, viral and fungal infections and others, are common effects of cortisone.

Now you will be able to understand the reason for the protocols we use at The Kornfeld Center. Rather than suppress the pathways of inflammation, we work to selectively stimulate the primary pathway of inflammation. This, as you remember, is the pathway of detoxification and repair. This is the pathway ultimately responsible for any and all healing. We do not have to suppress the secondary pathway when we are able to support the primary pathway and make it more efficient. When this is done, the body will naturally release the second pathway while concentrating on healing rather than protecting. This is accomplished with homeopathic injections, which are diluted natural substances capable of stimulating, rather than suppressing, the targeted physiologic pathway. In addition, there may be certain natural supplements and dietary changes that will be used along with the homeopathic injections. When we use protocols that support, rather than suppress, we naturally find a far lower incidence of side effects.