Archive For The “Corticosteroids” Category

The Recent Steroid Scare

By | October 8, 2012

I would like to use the recent epidural steroid scare as the jumping off point for a new series of blogs dealing with the best pain clinic in Los Angeles and its relentless pursuit of excellence. As many of you are probably aware there has been a recent nationwide epidemic of fungal meningitis, which has […]

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Chronic Steroid Side Effects: Muscle Wasting

By | January 23, 2012

Another serious side effect of long-term steroid administration is muscle wasting. Glucocorticoids change the body’s metabolism encouraging the breakdown of protein and the deposition of fat stores. The possible evolutionary benefit of such a change is not clear, but its implication in disease states is. Not only do muscles suffer, but cartilage, tendons, ligaments and […]

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Chronic Steroid Side Effects: Weight Gain

By | January 22, 2012

Another unwanted side effect of glucocorticoid therapy is weight gain.  At the doses we use in pain management this effect is usually mild and transient, but for patients on larger doses of steroids for longer periods of time the effects can be marked and irreversible.  Steroids promote weight gain by increasing fat deposition in the […]

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Chronic Steroid Side Effects: Osteoporosis

By | January 21, 2012

While not commonly seen in the doses used in the treatment of chronic pain, significant osteoporosis can occur with as little as 30 mg of hydrocortisone or 7.5 mg of prednisolone everyday for 3 months.  Steroid induced osteoporosis is most severe in the axial spine, but also affects the long bones.  Alternate day dosing, which […]

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Chronic Steroid Side Effects: Immunosuppression

By | January 18, 2012

Glucorticoids decrease the body’s natural immune mechanism by decreasing the number or function of circulating white blood cells. While not usually a problem at the doses we use in the management of chronic pain, at large doses the depression of the body’s immune response can be profound and widespread increasing the risk of bacterial, viral […]

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Chronic Steroid Side Effects: Introduction

By | January 14, 2012

Returning to our discussion of steroid therapy in pain management we will next discuss those side effects associated with long-term corticosteroid therapy. While the side effects of short-term steroid administration are generally transient and well tolerated, continued use of these hormones can produce devastating changes that are in many cases irreversible. These toxicities fall into […]

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Steroid Hormones: Anabolic Steroids, An Introduction

By | January 6, 2012

A friend of mine, whom I had successfully treated with series of steroid injections for cervical facet arthropathy, came up to me on the golf course last year with a smirk on his face, which suddenly turned into an angry growl. He announced that he was very upset with me. I calmly asked him why, […]

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Steroid Hormones: Glucocorticoids, Glucocorticoid Side Effects

By | January 5, 2012

The major undesired effect of glucocorticoids in pain management is its effect on glucose metabolism. These drugs increase blood glucose levels by increasing its production in the liver and by inhibiting its uptake and utilization in muscle and fat cells. This is a particular problem in our diabetic patients.  At the doses used acute depression […]

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Steroid Hormones: Glucocorticoids, Mineralocorticoid Side Effects

By | January 4, 2012

One of the problems with the pharmacologic uses of cortisone is that it cross-reacts extensively with mineralocorticoid receptors.  In fact the potency of cortisone in stimulating these receptors is equal to that of aldosterone, the major naturally occurring mineralocorticoid hormone.  The significance of this is obvious, salt and water retention and an unwanted increase in […]

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Steroid Hormones: Glucocorticoids, An Introduction

By | January 2, 2012

The most important naturally occurring glucocorticoid is cortisone. Its main actions are the control of glucose metabolism and immune modulation. Other actions include stimulation of arousal centers in the brain stem and limbic system, stimulation of maturation of lung and hematopoietic cells and as discussed in tomorrow’s blog cross reactivity with the mineralocorticoids. The primary […]

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