From the Guidelines
Pain management after taking corticosteroids should prioritize non-pharmacological approaches and cautious use of medications, given the potential for increased risk of adverse effects, as noted in recent guidelines 1.
Management Options
When considering management options for pain after corticosteroid use, it's essential to weigh the benefits and risks of various treatments.
- For mild to moderate pain, acetaminophen (Tylenol) at 325-650 mg every 4-6 hours (not exceeding 3000 mg daily) is often recommended due to its safety profile 1.
- Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can be effective but should be used cautiously with corticosteroids due to the increased risk of gastrointestinal bleeding 1.
- Topical analgesics such as diclofenac gel or lidocaine patches may help for localized pain.
- Non-medication approaches include:
- Applying ice to reduce inflammation (15-20 minutes several times daily)
- Gentle stretching exercises
- Physical therapy
- Adequate rest
- Maintaining proper hydration and nutrition to support healing
Considerations
It's crucial to consider the potential risks associated with corticosteroid use, including inflammation rebound, steroid-induced muscle weakness, and joint instability 1.
- The use of steroids can lead to secondary adrenal insufficiency and an altered immune response, among other adverse effects 1.
- Recent studies suggest that the duration of immune suppression could be less with the use of dexamethasone and betamethasone 1.
- Epidural injections of corticosteroids have been associated with serious adverse events, including death, spinal cord infarction, and paralysis 1.
Recommendations
Given the potential risks and benefits, a cautious approach to pain management after corticosteroid use is recommended, prioritizing non-pharmacological approaches and careful consideration of medication use 1.
- If pain is severe or persistent, consult a healthcare provider, as this could indicate steroid withdrawal symptoms or underlying conditions requiring different management.
From the Research
Management Options for Pain after Taking Corticosteroids
- The management of pain after taking corticosteroids can involve various approaches, including the use of alternative treatments such as acupuncture 2 or the administration of oral steroids 3.
- A study comparing acupuncture to oral corticosteroids found that acupuncture may have a greater improvement in symptom score at 13 months after treatment, with a lower rate of adverse events 2.
- Another study found that pain reduction after cervical steroid injection was not significantly different between patients who reported pain reduction with prior oral steroids and those who did not 3.
- The use of postoperative steroids to reduce pain and inflammation has been shown to be safe and effective, but further investigation is needed to fully understand its effects on wound and bone healing 4.
Systemic Absorption and Side Effects of Locally Injected Glucocorticoids
- Locally injected glucocorticoids can have systemic effects, including Cushing syndrome, loss of bone density, infection, and hyperglycemia 5.
- The concurrent use of oral steroids, the number of injections, and the type and dose of glucocorticoids used are important considerations in estimating risks 5.
- Caution should be exercised when using local glucocorticoid injections in higher risk patients, such as postmenopausal women, people with diabetes, and those considering surgery in the near term 5.
Short-Term Pain after Steroid Injection
- A study evaluating short-term pain after steroid injection found that there was no significant difference in pain levels between two different steroid preparations at 3 days and 3 weeks after injection 6.
- The study also found that short-term pain increased from baseline for both preparations and decreased from 3 days to 3 weeks 6.
- The significant correlation between short- and long-term pain may justify early decisions regarding treatment, especially in patients with high levels of initial pain 6.