From the Guidelines
Prednisone-induced neuropathy is a potential side effect of corticosteroid therapy that can be managed with dose reduction, gradual tapering, and alternative treatments, prioritizing patient morbidity, mortality, and quality of life. This condition typically develops during long-term prednisone use at higher doses or during rapid tapering of the medication. Symptoms often include tingling, numbness, burning sensations, or weakness that typically begins in the extremities, particularly the feet and hands. The mechanism behind this adverse effect involves steroid-mediated damage to nerve fibers, potentially through altered glucose metabolism, immune system modulation, or direct toxic effects on nerve cells.
Risk Factors and Management
Risk factors include diabetes, older age, and pre-existing neuropathic conditions. Management typically involves:
- Dose reduction when possible
- Gradual tapering rather than abrupt discontinuation
- Switching to alternative corticosteroids with different side effect profiles
- Supplementation with B vitamins, particularly B12, to support nerve health during treatment
- Pain management for symptomatic relief with medications like gabapentin or pregabalin, as suggested by 1 and 1
Treatment Approach
According to the most recent and highest quality study 1, the treatment approach for neuropathy should be based on the severity of symptoms, with options including neurology consultation, initiation of prednisone, and nonopioid management of neuropathic pain. In cases of severe or life-threatening symptoms, permanent discontinuation of the offending agent and ICU-level care may be necessary, as outlined in 1.
Quality of Life and Long-Term Follow-Up
Long-term follow-up should include clinical identification of residual neuropathy intensity and impact on quality of life, as well as the use of self-reporting questionnaires dedicated to neuropathy, such as the CIPN subscale of the EORTC QOL Questionnaire or the Module NTX of the FACT questionnaire, as recommended by 1. Supportive care, including physiotherapy, physical activity, and patient education, can also be helpful in managing neuropathy and improving patient quality of life.
From the Research
Prednisone Induced Neuropathy
- There is limited direct evidence on prednisone induced neuropathy, however, some studies suggest that prednisone can be used to treat certain types of neuropathy 2, 3, 4.
- A study published in the Journal of the peripheral nervous system found that four patients with acute small-fiber neuropathy responded dramatically to steroid therapy, including oral prednisone 2.
- Another study published in the Archives of neurology found that pulsed oral methylprednisolone therapy was effective in treating chronic inflammatory demyelinating polyneuropathy (CIDP) 3.
- A study published in Current treatment options in neurology found that high-dose prednisone is the standard platform therapy for patients with systemic and nonsystemic vasculitic neuropathy 4.
- However, there is no direct evidence on prednisone induced neuropathy, and more research is needed to fully understand the relationship between prednisone and neuropathy.
Treatment of Neuropathic Pain
- Some studies suggest that vitamin B12 may be effective in treating neuropathic pain, including post-herpetic neuralgia and painful peripheral neuropathy 5.
- Pregabalin has also been found to be effective in reducing pain and sleep interference in patients with neuropathic pain, but it increases the risk of adverse events 6.
- The treatment of neuropathic pain often involves a combination of medications and therapies, and the most effective treatment will depend on the individual patient and the underlying cause of their neuropathy.