Indications and Risks in Interventional Pain Management

Corticosteroids have been a mainstay in the interventional pain management because of their clinical effectiveness in treating numerous inflammatory subacute and chronic pain conditions.The common indications for corticosteroids can be divided into the following categories: Peripheral joints-Extra articular‚ tissue and Neuraxial structures and spaces . These agents include hydrocortisone, cortisone, prednisone,, methylprednisolone, triamcinolone, betamethasone an dexamethasone.high doses and/or chronic intake of corticosteroids are more likely to precipitate their known side effects than a single low dose injection.Since these drugs are metabolized in the liver and excreted by the kidney, patients with known renal or hepatic disease should be administered these drugs with caution. Local adverse reactions of corticosteroids are Alterations in skin pigmentation‚Atrophy of the subcutaneous and periarticular tissue.and Systemic Adverse Reactions to Corticosteroids include Fluid & Electrolyte Disturbance‚ Bone demiyelization ‚Gastrointestinal Disease‚ Impaired Glucose Metabolism ‚Central Nervous System Changes‚ Weight gain‚ Adrenal insufficiency ‚ Cushing syndrome ‚Allergic Reactions‚ facial flashing and inhibition of collagen synthesis .Concomitant drug intake should be carefully scrutinized prior to injecting a corticosteroid. often potentiate or diminish the drugs clearance and half-lives. Non-steroidal anti-inflammatory drugs,oral contraceptives and other exogenous estrogens are known to increase the potency of corticosteroids. Macrolide antibiotics may increase the potency of Methylprednisolone by decreasing its clearance . Individual agents exhibit varying properties of anti-inflammatory potency, salt retention properties, plasma half lives and duration of action. The decision to use specific agents is usually based on the preference and experience of the treating clinician, drug availability and the procedure to be performed