Joint Pain Treatment Options: Anti-Inflammatories, Cortisone, PRP, BPC-157 and Regenerative Medicine
- Dr. Stephanie Warner
- Aug 11
- 11 min read
When joint or musculoskeletal pain strikes, most people start with the treatments they already know. They may reach for Tylenol or an over-the-counter anti-inflammatory, use ice or heat, rest the area, or make an appointment with a physical therapist. And in many cases, these are perfectly reasonable places to start.
But what happens when the pain is severe, keeps coming back, or simply isn't improving?
Recently, a family member of mine experienced severe back pain and went to the emergency department three separate times. Each visit resulted in short-term treatment for the pain, followed by discharge—only for the pain to return and lead them back to the emergency department.
After the repeated visits, we discussed another option: if the pain and inflammation were truly that severe, would a corticosteroid injection be appropriate?
In the area where this family member lives, some of the regenerative treatments I commonly work with—such as peptide therapies and regenerative injections—aren't as readily accessible. A corticosteroid injection, however, was a treatment that could potentially be considered locally.
The experience reminded me how many patients simply don't know what their options are.
Someone experiencing severe back, knee, shoulder, hip or other musculoskeletal pain may be prescribed oral anti-inflammatories, short-term pain medications or muscle relaxants without ever having a conversation about injectable treatments—or about what may actually be causing the pain in the first place.
The goal shouldn't simply be to make pain disappear temporarily. It should be to understand where the pain is coming from, why it is occurring, and which treatment makes the most sense for both short-term relief and long-term joint health.
Depending on the diagnosis, treatment options may include:
Oral or topical anti-inflammatory medications
Natural and nutritional anti-inflammatory support
Physical therapy and rehabilitation
Corticosteroid injections
Platelet-rich plasma (PRP)
Peptide therapies such as BPC-157
Regenerative cellular or stem cell therapies
Each option has potential advantages, limitations and situations where it may—or may not—make sense.
Start With the Most Important Question: Why Does It Hurt?
Before deciding between an anti-inflammatory, cortisone shot or regenerative treatment, we first need to understand what we're treating.
Pain around a joint doesn't always mean the joint itself is the problem.
Pain may originate from cartilage, tendons, ligaments, muscles, bursae, the joint capsule or surrounding structures. Back pain can be even more complex, with potential contributions from muscles, facet joints, discs, nerves and other structures.
That distinction matters.
Suppressing inflammation may be very helpful for an acutely inflamed structure, but it isn't necessarily going to correct instability, repair an injured ligament or address an underlying mechanical problem.
This is why persistent, recurrent or severe pain deserves an appropriate evaluation rather than an endless cycle of temporarily suppressing symptoms.
When Should Joint or Musculoskeletal Pain Be Evaluated?
Consider seeking an evaluation when pain:
Persists despite reasonable rest and conservative treatment
Continues for several weeks
Repeatedly returns
Causes persistent or recurrent swelling
Limits your range of motion
Causes weakness or instability
Interferes with walking, exercise or everyday activities
Wakes you from sleep
Is associated with locking, catching or giving way
Occurs after a significant injury
Severe back pain accompanied by new weakness, numbness in the groin or saddle area, loss of bowel or bladder control, fever, or other significant neurological symptoms requires prompt medical evaluation.
Once serious causes have been excluded and the source of the pain is better understood, the conversation can shift from “How do we stop the pain today?” to “How do we actually treat this?”
Anti-Inflammatories and Short-Term Pain Management
For many people, medications are the first step.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can reduce inflammation and pain, while acetaminophen (Tylenol) can reduce pain but isn't considered an anti-inflammatory medication.
In certain circumstances, physicians may also prescribe muscle relaxants or other short-term medications.
These treatments can be valuable, particularly for an acute injury or flare. However, NSAIDs aren't appropriate for everyone and can have gastrointestinal, kidney and cardiovascular considerations, particularly with frequent or prolonged use.
The limitation of any pain-relieving medication is that symptom relief doesn't necessarily tell us why the problem occurred.
If someone repeatedly needs medication simply to function—or the pain immediately returns when the medication wears off—it may be time to investigate the underlying problem and consider additional treatment options.
Natural and Nutritional Anti-Inflammatory Support
Not every patient wants—or needs—to rely exclusively on conventional anti-inflammatory medications.
At Elixir and Wellness, some of our patients prefer a more integrative approach, and depending on the individual, we may discuss nutritional supplements or botanical compounds that have been studied for their effects on inflammation and joint health.
Some commonly considered options include:
Turmeric and Curcumin
Turmeric contains a group of active compounds known as curcuminoids, including curcumin. Curcumin has been extensively studied for its effects on inflammatory signaling and has also been investigated for symptoms associated with osteoarthritis.
One important consideration is absorption. Curcumin naturally has relatively poor bioavailability, so formulation can make a significant difference when selecting a product.
Boswellia
Boswellia serrata is a botanical traditionally used for inflammatory conditions. Its active boswellic acids influence inflammatory pathways and have been studied in patients with osteoarthritis and joint discomfort.
Turmeric and boswellia are also frequently combined in comprehensive joint-support formulas.
Omega-3 Fatty Acids
Fish oil provides the omega-3 fatty acids EPA and DHA, which play important roles in regulating inflammatory pathways throughout the body.
Omega-3 supplementation may be considered as part of a broader anti-inflammatory strategy, particularly when dietary intake of omega-3-rich foods is low.
Quercetin
Quercetin is a naturally occurring flavonoid found in many fruits and vegetables. It has antioxidant and anti-inflammatory properties and may be included in broader nutritional protocols designed to support a healthy inflammatory response.
Glucosamine and Chondroitin
Glucosamine and chondroitin are components of cartilage and are among the most commonly used supplements for joint health.
Research results have been mixed, and not every patient experiences improvement. However, some individuals with osteoarthritis report reductions in discomfort or improvements in function with these products.
CBD-Based Preparations
Some patients also choose topical or oral cannabidiol (CBD) products for musculoskeletal discomfort.
CBD interacts with the body's endocannabinoid system, which is involved in pain perception and inflammatory signaling. Research into CBD for musculoskeletal and arthritic pain continues to evolve, and product quality, formulation and dosing can vary considerably.
These natural options aren't automatically appropriate simply because they're available without a prescription. Supplements can interact with medications, affect bleeding risk or be inappropriate for certain medical conditions.
The goal at Elixir and Wellness is to select treatments based on the individual rather than simply recommending a long list of supplements.
And just like conventional pain medication, natural anti-inflammatory support shouldn't replace evaluating the underlying cause of persistent joint pain.
Cortisone Injections
Corticosteroid injections—often simply called cortisone shots—are another tool for managing significant musculoskeletal pain and inflammation.
And despite some of the concerns surrounding cortisone, there are situations where I think it can be an extremely useful treatment.
If inflammation is severe enough that someone can't move normally, sleep, participate in physical therapy or get through everyday activities, reducing that inflammation may provide an important window for recovery.
Cortisone can therefore be particularly useful when the immediate priority is controlling significant inflammation and pain.
But there is an important distinction:
Reducing inflammation and pain isn't necessarily the same thing as repairing injured tissue.
Corticosteroids primarily suppress inflammatory signaling. They don't rebuild damaged cartilage, tendons or ligaments.
That's why I view cortisone as a useful tool when appropriately selected rather than something that should automatically be repeated every time joint pain returns.
Not All Cortisone Injections Are the Same
There are several corticosteroid preparations available for injection, and they don't all have identical properties.
At Elixir and Wellness, when a corticosteroid injection is appropriate, we use dexamethasone sodium phosphate, which is a water-soluble, non-particulate corticosteroid.
Other commonly used injectable corticosteroids may be particulate preparations containing microscopic steroid crystals suspended in solution.
I prefer a non-particulate preparation when corticosteroid therapy is indicated because it allows us to achieve a corticosteroid's anti-inflammatory effect without injecting a crystalline particulate suspension.
That doesn't mean dexamethasone is completely without potential adverse effects. The effects of corticosteroids on musculoskeletal tissues can vary according to the specific medication, concentration, dose, frequency and injection location.
The larger principle is simple: cortisone should be used thoughtfully.
What Are the Downsides of Cortisone?
Cortisone can be very effective at reducing inflammation and pain. But repeated corticosteroid exposure isn't necessarily benign.
Potential considerations include:
Temporary post-injection pain or a “cortisone flare”
Temporary increases in blood glucose
Potential effects on cartilage cells and cartilage metabolism
Concerns about cartilage deterioration with repeated exposure
Tendon weakening when corticosteroids are repeatedly injected into or around certain tendons
Rare risk of infection
Relief of pain without correcting the underlying mechanical or structural problem
This is where the treatment decision becomes more nuanced.
Sometimes the immediate anti-inflammatory effect of cortisone is exactly what a patient needs.
For someone with a chronic degenerative problem, however, we may also want to ask whether repeatedly suppressing inflammation is the best long-term strategy—or whether a treatment intended to support tissue repair should be considered.
Platelet-Rich Plasma (PRP)
PRP takes a very different approach.
Platelet-rich plasma is created from the patient's own blood. A blood sample is collected and processed to concentrate platelets and plasma, which are then injected into the area being treated.
Platelets don't just participate in clotting. They also release numerous growth factors and signaling molecules involved in the body's response to injury and tissue repair.
PRP has been studied for orthopedic conditions including osteoarthritis and a variety of tendon and ligament injuries.
Unlike cortisone, PRP isn't designed to immediately suppress the body's inflammatory response. Some soreness following treatment can occur, and improvement tends to develop gradually over the following weeks and months.
For appropriately selected patients, this makes PRP an interesting option when the goal extends beyond short-term pain suppression toward supporting the body's repair processes.
BPC-157 and Pain Peptides
Peptide therapy is another emerging area of interest for musculoskeletal injuries.
One peptide frequently discussed in regenerative and sports medicine is BPC-157.
Preclinical research has explored BPC-157 in relation to processes involved in tissue repair, including tendon and ligament healing, angiogenesis and inflammatory signaling.
For certain musculoskeletal patients, BPC-157 may be considered as part of an individualized treatment plan involving joint, tendon, ligament or soft-tissue concerns.
Human clinical research remains limited compared with more established orthopedic treatments. BPC-157 in the July FDA meeting, it was voted in favor of approval according the the evidenca at hand. We are currently waiting for documents to be signed for it to be considered to be an FDA-approved product.
Regenerative Cellular and Stem Cell Joint Injections
For certain patients with joint degeneration or orthopedic injuries, regenerative cellular therapies may also be considered.
These treatments take yet another approach to musculoskeletal medicine: rather than primarily suppressing inflammation, the goal is to support the biological environment involved in tissue repair and recovery.
Regenerative cellular treatments may be considered for certain patients with chronic joint degeneration, osteoarthritis or orthopedic injuries, depending on the extent of the problem and the patient's overall health and treatment goals.
These treatments shouldn't be presented as a magic injection that creates an entirely new joint. The more realistic question is whether a regenerative approach may help improve pain, function and the environment in which healing occurs.
As with PRP and other regenerative procedures, appropriate patient selection is important.
Comparing Your Joint Pain Treatment Options
Treatment | Primary Goal | What to Consider |
NSAIDs / medication | Reduce pain and/or inflammation | Useful for short-term symptoms but may not address the underlying cause |
Natural anti-inflammatory support | Support healthy inflammatory pathways and joint health | Options include curcumin, boswellia, omega-3s, quercetin and others; selection should be individualized |
Cortisone / dexamethasone | Rapidly reduce significant inflammation and pain | Can be extremely useful when appropriately selected; repeated exposure requires consideration |
PRP | Support the body's tissue-repair response | Uses the patient's own platelets; improvement generally develops gradually |
BPC-157 | Support pathways associated with tissue repair | Emerging therapy with promising preclinical research but limited human clinical data |
Regenerative cellular / stem cell therapy | Support the biological environment for repair | May be considered for selected orthopedic and degenerative conditions |
So Which Treatment Is Right for Your Joint Pain?
The answer depends on what is actually causing the pain.
There are circumstances where physical therapy and conservative treatment are the right first step. There are circumstances where inflammation is so significant that a corticosteroid injection can be incredibly helpful. And there are patients for whom PRP, peptide therapy or regenerative cellular treatments may be worth considering.
These approaches don't necessarily have to exist in opposition to one another.
The important part is determining what you're treating and what you're trying to accomplish.
Are we trying to control an acute inflammatory flare?
Are we trying to get someone comfortable enough to participate in rehabilitation?
Are we dealing with chronic degeneration?
Is there a tendon or ligament injury that needs an opportunity to heal?
Or are we repeatedly treating pain without determining why it keeps coming back?
Those questions help determine whether the best next step is medication, nutritional support, rehabilitation, cortisone or a regenerative approach.
At Elixir and Wellness in Scottsdale, Arizona, our approach to musculoskeletal pain begins with evaluating the problem and then discussing treatment options based on the individual patient, the injury and their long-term goals.
Because the best treatment for joint pain isn't necessarily the strongest pain reliever—it's the treatment that makes the most sense for what is actually causing the pain.
Frequently Asked Questions About Joint Pain Treatments
Is cortisone bad for your joints?
Cortisone isn't inherently “bad,” and corticosteroid injections can be very useful for reducing significant inflammation and pain. However, research has raised concerns about the effects of repeated corticosteroid exposure on cartilage and other musculoskeletal tissues. The potential benefits and risks should therefore be considered for the individual patient rather than treating cortisone as either universally good or universally bad.
How many cortisone shots can you have?
There isn't one number that's appropriate for every patient or every joint. The frequency of injections should take into account the condition being treated, the corticosteroid used, previous response, overall health and potential effects of repeated exposure. If pain continually returns after corticosteroid injections, it may also be worth reconsidering the underlying diagnosis and treatment strategy.
Is PRP better than cortisone for joint pain?
They serve different purposes. Corticosteroids are primarily used to rapidly reduce inflammation, whereas PRP is intended to support biological processes involved in tissue repair. Which is more appropriate depends on the diagnosis, severity of symptoms and treatment goals.
How long does PRP take to work?
PRP isn't typically an immediate pain-relieving treatment. Patients may experience temporary soreness after treatment, followed by gradual improvement over several weeks. Changes may continue over subsequent months depending on the condition and individual response.
What is BPC-157 used for?
BPC-157 is a peptide being investigated for potential effects on tissue repair, inflammatory signaling, angiogenesis, and tendon and ligament healing. Much of the current evidence is preclinical, and human research remains limited.
Can supplements help joint pain?
Certain nutritional compounds—including curcumin, boswellia and omega-3 fatty acids—have been studied for their effects on inflammatory pathways and joint symptoms. Glucosamine and chondroitin are also commonly used for osteoarthritis, although study results have been mixed. Supplements are best selected based on the individual rather than assuming that every “joint supplement” is appropriate for everyone.
When should I consider regenerative medicine for joint pain?
Regenerative treatments may be worth discussing when pain is persistent or recurrent, conservative treatments haven't provided sufficient improvement, or an orthopedic condition involves degenerative or injured tissue that may benefit from a different therapeutic approach. The type and severity of the injury and the patient's overall health are important considerations.
Do I need an MRI before a joint injection?
Not necessarily. Imaging needs depend on the history, physical examination, suspected diagnosis and type of treatment being considered. Some patients may benefit from X-rays, MRI or other imaging before treatment, while others may not require advanced imaging.
References
McAlindon TE, LaValley MP, Harvey WF, et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: a randomized clinical trial. JAMA. 2017;317(19):1967-1975.
Wernecke C, Braun HJ, Dragoo JL. The effect of intra-articular corticosteroids on articular cartilage: a systematic review. Orthopaedic Journal of Sports Medicine. 2015;3(5):2325967115581163.
Belk JW, Kraeutler MJ, Houck DA, Goodrich JA, Dragoo JL, McCarty EC. Platelet-rich plasma versus hyaluronic acid for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. American Journal of Sports Medicine. 2021;49(1):249-260.
Hewlings SJ, Kalman DS. Curcumin: a review of its effects on human health. Foods. 2017;6(10):92.
Bannuru RR, Osani MC, Al-Eid F, Wang C. Efficacy of curcumin and Boswellia for knee osteoarthritis: systematic review and meta-analysis. Seminars in Arthritis and Rheumatism. 2018;48(3):416-429.
Senftleber NK, Nielsen SM, Andersen JR, et al. Marine oil supplements for arthritis pain: a systematic review and meta-analysis of randomized trials. Nutrients. 2017;9(1):42.
Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. New England Journal of Medicine. 2006;354:795-808.
Sikiric P, Seiwerth S, Rucman R, et al. Stable gastric pentadecapeptide BPC 157: novel therapy in gastrointestinal tract. Current Pharmaceutical Design. 2011;17(16):1612-1632.
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