Use of Corticosteroids in Advance Pain Management

Triamcinolone Diacetate 

The medication helps in the treatment of non-Hodgkin’s lymphoma, hypersensitivity drug reaction, Trichinae Parasite infection, rejection of a transplanted organ, infiltration of white blood cells to the lungs, obliteration of red blood cells by one’s antibodies, Crohn’s disease, nephritic syndrome, giant hives, Beryllium poisoning, Leukemia, and accumulation of fluid in one’s brain ( Rommer et al., 2016). Organ transplant often come with pain to the patient, and it becomes worse when the transplanted organ is rejected. Thus, the medication helps in relieving pain after an organ transplant exercise. The use of the medication has severe side effects that includes chronic troubled sleeping, secretion of excess stomach acids, increased blood sugar level, bleeding of the stomach, diabetes, Cushing’s syndrome, water retention, high levels of sodium in the blood, abnormal heart rhythm, chronic heart failure, blood clot in the vein, and cataract. Notably, a person will also experience confusion and depression after using the medication. Some people can also experience impaired wound healing, muscle problems, and decreased amount of potassium in their blood. 

Methylprednisolone Sodium Succinate 

The medication is used in the treatment of conditions such as blood disorder, arthritis, certain cancers, severe allergic reactions, immune system disorders, lung/ intestinal, kidney diseases among others. It is imperative to indicate that injectable form of the medication is used particularly when a patient cannot take a related drug by mouth when the situation demands a swift response common in patients with severe medical conditions. The medication helps in advance pain management particularly in patients with kidney failures after undergoing dialysis. The medication reduces one’s immune system’s response to various ailments ( Fehlings et al., 2017). Methylprednisolone also serves to alleviate symptoms that include pain, swelling, and all allergic-type reactions. The use of the medication in chronic pain management comes along with severe side effects to the patient such as headache, troubled sleeping, heartburn, nausea, appetite change, vomiting, increased sweating and redness, pain, and swelling at the site of the injection. The medication also increases one’s blood sugar level, which worsens diabetes. Muscle weaknesses, unusual weight gain, puffy face, and persistent sore throat may also present as side effects to the use of the medication. One ought to take precaution before using the medication, especially for individuals with allergic reactions, as the drug contain ingredients such as lactose. 

Triamcinolone Hexacetonide 

The medication helps in the treatment of skin disease characterized mostly by swollen itching lesions, plaque psoriasis, and rheumatoid arthritis. In addition, the medication treats inflammation of the covering tendon and any disease that comes after the trauma that involves joint cartilage. Equally important, the drug helps in the treatment of acute inflammation of the Bursa and skin lesion related to diabetes mellitus ( Hangody et al., 2018). Importantly, the medication helps to relieve patients from pain, especially those with terminal conditions that cause itching lesions. The medication has various side effects such as increased blood sugar level and disorders that involve personality changes. Notably, the use of the medication increases inflammation of the skin mostly caused by allergy and life threatening allergic reactions from the body. One might also experience muscle weakness, muscle problems, and increased pressure in the eye. Some individuals experience ulcers that arise from stomach acid and drastic weight gain. However, it is advisable for one to consult a physician before using the drug and indicate whether he or she reacts to any of the drug’s ingredients. 

Hydrocortisone Sodium Succinate 

The medication is used in the treatment of various conditions such as arthritis, blood diseases, certain cancers, intestinal disorders, skins diseases, breathing problems, and severe allergies. The drug weakness one’ immune’s response to multiple diseases such as allergic reactions and swelling. Equally important to note is that Hydrocortisone can be used alongside other drugs to replace certain hormones if one experiences decreased adrenal gland function commonly known as Addison’s disease ( Hammerich et al., 2019). In advance pain management, the medication helps in relieving cancer patients from pain arising from the chemotherapy sessions. Hydrocortisone belongs to a special group of drugs called corticosteroids. Moreover, hydrocortisone injection plays a crucial role in situations where a similar drug cannot be administered by mouth or in situations where a patient needs speedy treatment more so those with severe medical conditions. 

Using the drug entails injecting the medication slowly into the vein or sometimes directly into the patient’s muscle. A person’s medical condition, as well as response to treatment, determine the dosage administered. However, one is supposed to continue using the medication and can only stop using after consulting a doctor. Some patients’ condition may become worse when the individual stops using the drug suddenly ( Hammerich et al., 2019). A person under the medication may experience symptoms such as weight loss, muscle pain, tiredness, nausea, headache, and dizziness. However, one can prevent the occurrence of the above symptoms if the individual can reduce the dosage gradually. 

Dexamethasone Sodium Phosphate 

The medication may act as an anti-inflammatory, whereby it relieves patients’ inflammation in various parts of one’s body. The drug is used to decrease swelling common with tumors of the brain and the spine ( Cázares-Delgadillo, Ganem-Rondero, Merino and Kalia, 2016). The medication is also used to treat eye inflammation alongside allergic reactions. The drug can also be used to treat certain types of autoimmune diseases, asthma, skin conditions, and other lung conditions. Besides, the drug helps in the treatment of various kinds of cancers such as lymphoma, myeloma, and leukemia. Importantly, the medication is used for relieving patients from pain caused by inflammation of various body parts caused by diseases. 

Moreover, in cancer patients, the medication is used to stimulate appetite particularly in patients who experience severe appetite challenges. The drug is administered in many forms, which can either be a pill or infusion into the patient's vein. Dexamethasone eye drops are also administered to prevent various eye conditions. The eye drops are applied mostly to patients with leukemia to avoid the inflammation of the eyes ( Hammerich et al., 2019). The medication comes with various side effects to the user such as heartburn, impaired wound healing, muscles weakness, difficulty in sleeping, and an increase in blood sugar levels. Dizziness, headaches and mood swings may also present themselves as symptoms even though they remain less common amongst many patients. In advance pain management, the drugs help in relieving cancer patients from the pain that arises from chemotherapy activities and is mostly administered after the activity. 

Betamethasone 

Betamethasone refers to a steroid medication used in the treatment of some diseases such as rheumatoid arthritis, systemic lupus erythematosus, psoriasis, allergic reaction reactions such as asthma as well as angioedema, Crohn’s disease, and leukemia among others. The drug has some serious side effects such as increased infection risk, muscle weakness, psychosis, and severe allergic reactions ( Sidgiddi, Pakunlu, & Allenby, 2018). Importantly, the prolonged use of the medication causes adrenal insufficiency. The medication is used in pain management for rheumatoid arthritis patients where it is administered after a given interval. 

Methylprednisolone Acetate Vial 

Methylprednisolone is used in the treatment of pain as well as swelling that occurs as a result of arthritis and joint disorders. Importantly, the medication helps to relieve arthritis patients of their pain in advance pain management intervention. The medication helps in the treatment of other conditions such as severe allergic reactions, eye conditions, blood disorders, immune system disorders, and kidney/lung diseases. Ideally, the medication boosts one’s immune systems’ response to the named conditions while at the same time reduces symptoms that include pain, swelling, and allergic-type reactions ( McCrum, 2017). The medication is injected directly into the joint of the patient or a muscle or abnormal skin tissue. A patient’s dose depends on one’s medical condition as well as response to treatment. 

Triamcinolone Acetonide 

The medication helps in the treatment of various skin conditions such as allergies, eczema, and rash. Triamcinolone reduces itching, swelling, as well as redness that occurs in those types of situations. The medication stands as a medium-to-strong potency corticosteroid ( Conaghan et al., 2018). Importantly, the potency largely depends on the strength and form that one uses. The medication helps in advance pain management for patients suffering from terminal conditions diabetes that causes swelling of legs. 

Advantages and Disadvantages of Particulate vs non-particulate CSs 

Particulate CSS 

Advantages 

Particulate CSS have a longer lasting relief of symptoms power 

Disadvantage 

Particulate CSS have an increased peril for occlusion of tiny vessels found in the arterial tree as a possible consequence following accidental radiculomedullary artery steroid jab. 

Particulate CSS also causes infarction of the cerebellum and brainstem and 

Non-particulate CSS 

Advantage 

Non-particulate CSS have an advantage of superior safety as well as comparable efficacy in pain reduction. 

Disadvantage 

Non-particulate CSS have a shorter relief of symptoms power 

Safe Injection Sites 

The epidural space that is caudal to the inferior edge of the pedicle provides a safe needle site within the neuroforamen. Moreover, for the CT-guided posterolateral injections, the safe needle sites will be in the posterior epidural fat located in the lateral and posterior aspect of the neural foramen ( Conaghan et al., 2018). The Kambin Triangle Approach also provides a safe as well as convenient access for percutaneous discectomy and transforaminal injections. 

Possible Adverse Effects that Could Occur 

Adverse events that occur during injection include hemorrhage, vasovagal reactions, nerve or vessel damage, and reaction to contrast material. Immediately after injection, the following adverse effects could occur; hemorrhage, pain, paresthesia, and extreme weakness. Some effects such as infection, headache, and flushing reaction to steroids may occur days later ( Conaghan et al., 2018). Notably, bleeding risks increases with one’s age, the severity of spondylopathy, underlying coagulopathy, and difficulty of needle placement. Moreover, bleeding risks increases particularly in patients under multiple anticoagulant and antiplatelet medications. The procedures also expose the patient to Epidural hematoma, which stands as a significant threat due to the spinal cord and may need surgical evacuation to avoid neurologic sequelae. 

Notably, injected steroids demonstrate systematic glucocorticoid consequences on top of the local anti-inflammatory effects. Other undesired effects include an increase in the blood glucose level, suppression of the hypothalamic-pituitary axis, and destruction of the immune system. It is essential to indicate that repeated steroid injections, particularly at short intervals of less than eight weeks, especially of particulate nature, can inhibit full recovery of the hypothalamic-pituitary axis and can decrease bone mineral density ( Hammerich et al., 2019). Moreover, patients with paresthesia or baseline weaknesses have a high susceptibility to anesthetic effects and at times develop profound post-procedural weaknesses when administered with even a small volume of anesthetic. 

References 

Cázares-Delgadillo, J., Ganem-Rondero, A., Merino, V., & Kalia, Y. N. (2016). Controlled transdermal iontophoresis for poly-pharmacotherapy: Simultaneous delivery of granisetron, metoclopramide and dexamethasone sodium phosphate in vitro and in vivo.  European journal of pharmaceutical sciences ,  85 , 31-38. 

Conaghan, P. G., Hunter, D. J., Cohen, S. B., Kraus, V. B., Berenbaum, F., Lieberman, J. R., ... & Burgess, D. J. (2018). Effects of a single intra-articular injection of a microsphere formulation of triamcinolone acetonide on knee osteoarthritis pain: a double-blinded, randomized, placebo-controlled, multinational study.  The Journal of bone and joint surgery. American volume ,  100 (8), 666. 

Fehlings, M. G., Wilson, J. R., Harrop, J. S., Kwon, B. K., Tetreault, L. A., Arnold, P. M., ... & Dettori, J. R. (2017). Efficacy and safety of methylprednisolone sodium succinate in acute spinal cord injury: a systematic review.  Global spine journal ,  7 (3_suppl), 116S-137S. 

Hangody, L., Szody, R., Lukasik, P., Zgadzaj, W., Lénárt, E., Dokoupilova, E., ... & Hangody, G. (2018). Intraarticular injection of a cross-linked sodium hyaluronate combined with triamcinolone hexacetonide (Cingal) to provide symptomatic relief of osteoarthritis of the knee: a randomized, double-blind, placebo-controlled multicenter clinical trial.  Cartilage ,  9 (3), 276-283. 

Hughes, R. A., Mehndiratta, M. M., & Rajabally, Y. A. (2017). Corticosteroids for chronic inflammatory demyelinating polyradiculoneuropathy.  Cochrane Database of Systematic Reviews , (11). 

McCrum, C. (2017). Therapeutic Review of Methylprednisolone Acetate Intra ‐ Articular Injection in the Management of Osteoarthritis of the Knee–Part 1: Clinical Effectiveness.  Musculoskeletal Care ,  15 (1), 79-88. 

Rommer, P. S., Kamin, F., Abu ‐ Mugheisib, M., Koehler, W., Hoffmann, F., Winkelmann, A., ... & Zettl, U. K. (2016). Long ‐ Term Effects of Repeated Cycles of Intrathecal Triamcinolone Acetonide on Spasticity in MS Patients.  CNS Neuroscience & Therapeutics ,  22 (1), 74-79. 

Sidgiddi, S., Pakunlu, R. I., & Allenby, K. (2018). Efficacy, Safety, and Potency of Betamethasone Dipropionate Spray 0.05%: A Treatment for Adults with Mild-to-moderate Plaque Psoriasis.  The Journal Of Clinical And Aesthetic Dermatology ,  11 (4), 14.