The mechanism of action and side effects of epidural steroids

Techniques in Regional Anesthesia and Pain Management

Volumn 13, Issue 4, 2009, Pages 205-211

  Baqai, Aisha ^a   Bal, Rajpreet ^a  

^a New York Weill Cornell Center   (United States)

Author keywords

Diabetes; Epidural steroid injection; Hypertension; Mechanisms of action; Osteoporosis; Side effects

Indexed keywords

ARACHIDONIC ACID; BRADYKININ; CALCITONIN GENE RELATED PEPTIDE; CORTICOSTEROID; CYCLOOXYGENASE 2; GLUCOCORTICOID; GLUCOCORTICOID RECEPTOR; HYDROCORTISONE; ICOSANOID; LEUKOTRIENE; LIPOXYGENASE; LOCAL ANESTHETIC AGENT; MEPREDNISONE; NONSTEROID ANTIINFLAMMATORY AGENT; NORADRENALIN; OSTEOCLAST DIFFERENTIATION FACTOR; PHOSPHOLIPASE A2; PROSTAGLANDIN; SEROTONIN; SEROTONIN 6 RECEPTOR; SODIUM CHLORIDE; STEROID; SUBSTANCE P; THROMBOXANE; TRANSFORMING GROWTH FACTOR BETA; VASOACTIVE INTESTINAL POLYPEPTIDE;

ABSCESS; ADRENAL SUPPRESSION; AMENORRHEA; ANALGESIC ACTIVITY; ANTIINFLAMMATORY ACTIVITY; ANXIETY; ARTHRALGIA; ARTICLE; AVASCULAR NECROSIS; BACKACHE; BONE NECROSIS; CONGESTIVE HEART FAILURE; CONSTIPATION; CORTICOSTEROID INDUCED OSTEOPOROSIS; CUSHINGOID SYNDROME; CYTOKINE PRODUCTION; DEEP VEIN THROMBOSIS; DEPRESSION; DERMATITIS; DIABETES MELLITUS; DIARRHEA; DOWN REGULATION; DRUG EFFECT; DRUG FEVER; DRUG FORMULATION; DRUG INDUCED HEADACHE; DRUG INSTILLATION; DRUG MECHANISM; DRUG RECEPTOR BINDING; ECCHYMOSIS; ENZYME INHIBITION; EPIDURAL ANESTHESIA; EUPHORIA; EXOPHTHALMOS; FLUID RETENTION; FLUSHING; GENE EXPRESSION REGULATION; GLAUCOMA; GLUCOSURIA; GROWTH RETARDATION; HIRSUTISM; HUMAN; HYDROCORTISONE BLOOD LEVEL; HYPERCORTISOLISM; HYPERGLYCEMIA; HYPERPIGMENTATION; HYPERTENSION; HYPOKALEMIA; HYPOPIGMENTATION; IMMUNE DEFICIENCY; INFLAMMATION; INSOMNIA; INSULIN RESISTANCE; INTRAOCULAR PRESSURE; ISCHIALGIA; LIPOMATOSIS; LOW BACK PAIN; MEDIATOR RELEASE; MENSTRUATION DISORDER; MOLECULAR MECHANICS; MOOD DISORDER; MOTOR ACTIVITY; MUSCLE ATROPHY; MYALGIA; MYCOSIS; NERVE FIBER C; NEUROMODULATION; NEUROPATHY; NEUROTRANSMISSION; NITROGEN BALANCE; NOCICEPTION; OPTIC NERVE INJURY; OSMOLALITY; OSTEOPENIA; PATHOLOGIC FRACTURE; PATHOPHYSIOLOGY; PEPTIC ULCER; PETECHIA; PSYCHOSIS; RESTLESSNESS; RETINA HEMORRHAGE; SECONDARY INFECTION; SEIZURE; SIDE EFFECT; SINGLE DRUG DOSE; SKIN ATROPHY; SODIUM RETENTION; STEROID THERAPY; STOMACH HEMORRHAGE; SUBCAPSULAR CATARACT; SYSTEMIC VASCULAR RESISTANCE; TRANSACTIVATION; ULCERATIVE ESOPHAGITIS; UPREGULATION; URTICARIA; VERTIGO; VIRUS INFECTION; WATER RETENTION; WOUND HEALING IMPAIRMENT;

EID: 71549157101     PISSN: 1084208X     EISSN: None     Source Type: Journal    
DOI: 10.1053/j.trap.2009.06.009     Document Type: Article

References (29)

1. Manchikanti L., and Singh V. Interventional Techniques in Chronic Spinal Pain. Chapter 23: Lumbar Interlaminar Epidural Steroid Injections (2007), ASIPP Publishing, Paducah, KY
2. Manchikanti L., and Singh V. Interventional Techniques in Chronic Spinal Pain. Chapter 11: Pharmacology of Neuraxial Steroids (2007), ASIPP Publishing, Paducah, KY
3. Saal J.S. The role of inflammation in lumbar pain. Spine 20 (1995) 1821-1827
4. Imboden J., Goodwin J.S., Davis J., et al. Immunosuppressive, anti-inflammatory, and immunomodulatory therapy. In: Parslow T.G., Stites D.P., Terri A.I., and Imboden J.B. (Eds). Medical Immunology. ed 10 (2001), McGraw Hill, New York, NY
5. Liberman A.C., Druker J., Garcia F.A., et al. Intracellular molecular signaling. Ann NY Acad Sci 1153 (2009) 6-13
6. Schacke H., Docke W.D., and Asadullah K. Mechanisms involved in the side effects of glucocorticoids. Pharmacol Ther 96 (2002) 23-43
7. Kuslich S.D., Ulstrom C.L., and Michael C.J. The tissue origin of low back pain and sciatica: A report of pain response to tissue stimulation during operation on the lumbar spine using local anesthesia. Orthop Clin North Am 22 (1991) 181-187
8. Wheeler A.H., and Murrey D.B. Chronic lumbar spine and radicular pain: Pathophysiology and treatment. Curr Pain Headache Rep 6 (2002) 97-105
9. Hoyland J.A., Freemont A.J., and Jayson M.I.V. Intervertebral venous obstruction. A cause of periradicular fibrosis. Spine 14 (1989) 558-568
10. McClain R.F., Kapural L., and Mekhail N.A. Epidural steroid therapy for back and leg pain: Mechanisms of action and efficacy. Spine J 5 (2005) 191-201
11. Mulleman D., Mammou S., Griffoul I., et al. Pathophysiology of disk-related sciatica. I. Evidence supporting a chemical component. Joint Bone Spine 73 (2006) 151-158
12. Peng B., Wu W., Li Z., et al. Chemical radiculitis. Pain 127 (2007) 11-16
13. Patte-Mensah C., Kibaly C., Boudard D., et al. Neurogenic pain and steroid synthesis in the spinal cord. J Mol Neurosci 28 (2006) 17-31
14. Mensah-Nyagan A.G., Kibaly C., Schaeffer V., et al. Endogenous steroid production in the spinal cord and potential involvement in neuropathic pain modulation. J Steroid Biochem Mol Biol 109 (2008) 286-293
15. Patte-Mensah C., Kibaly C., and Mensah-Nyagan A.G. Substance P inhibits progesterone conversion into neuroactive metabolites in spinal sensory circuit: A potential component of nociception. Proc Natl Acad Sci U S A 102 (2005) 9044-9049
16. Kibaly C., Meyer L., Patte-Mensah C., et al. Biochemical and functional evidence for the control of pain mechanisms by dehydroepiandrosterone endogenously synthesized in the spinal cord. FASEB J 22 (2008) 93-104
17. Johansson A., Hao J., and Sjolund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibers. Acta Anaesthesiol Scand 34 (1990) 335-338
18. Van Burskirk C., Poffenbarger A.L., Capriles L.F., et al. Treatment of multiple sclerosis with intrathecal steroids. Neurology 14 (1964) 595-597
19. Fuxe K., Harfstrand A., and Agnati F.L. Immunocytochemical studies on the localization of glucocorticoid receptor immunoreactive nerve cells in the lower brain stem and spinal cord of the male rat using a monoclonal antibody against rat liver glucocorticoid receptor. Neurosci Lett 60 (1985) 1-6
20. Finn D.P., Fone K.C.F., Beckett S.R.G., et al. The effects of pharmacological blockade of the 5-HT6 receptor on Formalin-evoked nociceptive behavior, locomotor activity and hypothalamo-pituitary-adrenal axis activity in rats. Eur J Pharmacol 569 (2007) 59-63
21. Chaouloff F. Regulation of 5-HT receptors by corticosteroids: Where do we stand?. Fundam Clin Pharmacol 9 (1995) 219-233
22. Fukisaki M., Kobayashi I., Hara T., et al. Symptoms of spinal stenosis after epidural steroid injection. Clin J Pain 14 (1998) 148-151
23. Lansang M.C., Farmer T., and Kennedy L. Diagnosing the unrecognized systemic absorption of intra-articular and epidural steroid injections. Endocr Pract 15 (2009) 225-228
24. Whitworth J.A., Williamson P.M., Mangos G., et al. Cardiovascular consequences of cortisol excess. Vasc Health Risk Manag 1 (2005) 291-299
25. Tauchamanova L., Rossi R., Biondi B., et al. Patients with subclinical Cushing's syndrome due to adrenal adenoma have increased cardiovascular risk. J Clin Endocrinol Metab 87 (2002) 4872-4878
26. Faggiano A., Pivonello R., Spiezia S., et al. Cardiovascular risk factors and common carotid artery caliber and stiffness in patients with Cushing's disease during active disease and 1 year after disease remission. J Clin Endocrinol Metab 88 (2003) 2527-2533
27. Younes M., Neffati F., Touzi M., et al. Systemic effects of epidural and intra-articular glucocorticoid injections in diabetic and non-diabetic patients. Joint Bone Spine 74 (2007) 472-476
28. Ward A., Watson J., Wood P., et al. Glucocorticoid epidural for sciatica: Metabolic and endocrine sequelae. Rheumatology 41 (2002) 68-71
29. Brotman D.J., Girod J.P., Garcia M.J., et al. Effects of short-term glucocorticoids on cardiovascular biomarkers. J Clin Endocrinol Metab 90 (2009) 3202-3208