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Sally’s Story: Opioid Usage Over a Number of Years in a Chronic Pain Patient
Published in Michael S. Margoles, Richard Weiner, Chronic PAIN, 2019
When Dr. Smith evaluated her, the ankle reflex was absent on the right side. He suspected that she might have ruptured a disc during the fall. He referred Sally to a neurosurgeon, Dr. Worthington, and an orthopedic surgeon, Dr. Swartz, for surgical evaluation. A lumbar MRI and discogram were performed. The findings showed small to moderate disc bulges at L4-L5 and L5-S1. The surgeons were not convinced that surgery was needed at the time, but indicated that the situation could get worse over time. They recommended an epidural steroid injection.
Chronic Pain
Published in Andrew Stevens, James Raftery, Jonathan Mant, Sue Simpson, Health Care Needs Assessment, 2018
Henry J. McQuay, Lesley A. Smith, R. Andrew Moore
Two other common pain clinic procedures particularly for back pain are epidural steroid injection and facet nerve blocks. However, there is considerable current controversy about the potential for epidural steroid to produce long-term neurological sequelae. Intrathecal injection of steroid can produce neurological sequelae. It is therefore important that intrathecal injection is avoided.
Neck and shoulder pain
Published in Gill Wakley, Ruth Chambers, Paul Dieppe, Musculoskeletal Matters in Primary Care, 2018
Gill Wakley, Ruth Chambers, Paul Dieppe
Surgical treatment was compared with conservative treatment for neck pain with neurological pain, and no difference was found at 1-year follow-up. Epidural steroid injection was only reported in case studies, so no clear conclusions could be drawn. The ABC of Rheumatology26 suggests that epidural steroid injection might help to identify which patients might benefit from surgical treatment.
Managing the Incurable: Older Pain Clinic Patients’ Experiences of Managing Treatment-Resistant Chronic Low Back Pain
Published in Journal of Gerontological Social Work, 2021
A total of 21 older adults recruited from five pain clinics completed 23 interviews for this study, and the median length of interview was 61 minutes. Participants were being seen by the specialty pain clinic for reasons related to medication management and/or spinal procedures, with all individuals having received at least one epidural steroid injection. The average age of participants was 71 years (SD = 5.5), and the average length of time participants had been living with CLBP was 19 years. The sample was comprised entirely of Caucasian and non-Latino individuals, of which 13 were female and eight were male. Regarding marital status, 16 participants were married or in domestic partnerships, two were divorced, two were widowed, and one person was single. All but four participants were living with someone (significant other, caregiver, etc.) at the time of the study. Regarding employment status, all participants were retired except for three full-time employed individuals and one individual receiving disability benefits. As measured and interpreted by the Owestry Disability Index 2.0 (Baker et al., 1989; Fairbank & Pynsent, 2000), participants had a substantial level of pain-related disability: minimal (n = 2), moderate (n = 10), and severe (n = 9) disability. See Stensland and Sanders (2018b) for further description of sample characteristics.
Treatment of pemphigus vulgaris: part 1 – current therapies
Published in Expert Review of Clinical Immunology, 2019
Rebecca L. Yanovsky, Michael McLeod, A. Razzaque Ahmed
Abnormal uterine bleeding (AUB) is a rarely reported side effect of CS therapy. Pathophysiology likely involves suppression of pituitary hormones stimulating menstruation or could be a side effect of corticosteroid-induced adrenal insufficiency leading to a decrease in gonadotropin releasing hormone. A case series identified 3 out of 3000 pemphigus patients (incidence 0.1%) who developed AUB after treatment with CS. Regardless, AUB can be a significant side effect in PV since it affects females and may be underreported due to limited history taking and lack of self-reporting among female patients [30]. Amongst these cases, one PV patient developed AUB after a single dose of 25mg of prednisone and subsequently a second dose of 40mg of prednisone. Another developed AUB after a single dose of 40 mg of prednisone. In two of three women, AUB disappeared after discontinuation of corticosteroid therapy. In the third woman, the AUB resolved on its own while she was still on CS therapy, but the mode of administration was altered. Menstrual irregularities have primarily involved menorrhagia [30]. Epidural steroid injection has been shown to cause abnormal uterine bleeding in up to 2.5% of pre- and post-menopausal women [31]. This observation is significant. Without the knowledge that corticosteroid therapy may be related to AUB, women who seek medical attention for AUB may undergo invasive testing and surgical procedures that are not required. Clinical AUB should be discussed with female patients with PV before initiating high-dose, long-term CS therapy.
Perineal pruritus in epidural dexamethasone injections
Published in Canadian Journal of Pain, 2019
Catherine Veilleux, Aline Boulanger
Intravenous dexamethasone has been reported to induce short-lived sensations such as burning, itching, and tingling in the perineal region,1–4 with most cases reported among women. The mechanism behind this reaction is currently unknown and not all types of corticosteroids have been associated with this adverse reaction.5 It has been postulated that this adverse reaction may be caused by the phosphate ester of the dexamethasone sodium phosphate,4 providing an explanation for why it has not been reported with intravenous methylprednisolone injections. There are only a few reports of burning sensations in the perineal region with epidural dexamethasone injections. One case of generalized pruritus originating from the groin area has been reported after a transforaminal epidural dexamethasone injection.6 Much like adverse reactions described with intravenous injections, the reaction described began soon after the injection was completed and was short-lived. The authors of this case report then conducted a prospective study to determine the adverse effects immediately following transforaminal epidural steroid injection for the treatment of radicular pain.7 Their results showed that 7 out of 150 patients (4.6% of patients) experienced a similar short-lived perineal pruritus following procedures involving epidural dexamethasone injection. This adverse effect was not reported with epidural injections with steroids other than dexamethasone. The authors proposed that this adverse effect was possibly related to a rapid injection of the medication, an unrecognized vascular injection, or both mechanisms.7