Injection after oral steroid

[ctts]

If a patient just took a course of oral steroids (within last few days, usually from PCP) or finishing up a course, but still with significant pain, and comes in wanting an injection, would you have them wait (1-2 weeks?) before doing a steroid injection? Or do you go ahead and do it?

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[lobelsteve]

Based on there never being a role for oral steroids for spinal pathology other than possibly SCI, just inject them, then educate the PCPs and Surgeons to stop the insanity.

 

[Birdstrike]

Likely not news to any of you, but see recent study on oral steroids in back pain:

http://www.ncbi.nlm.nih.gov/m/pubmed/24739318/

"CONCLUSION: We detected no benefit from oral corticosteroids in our ED patients with musculoskeletal LBP."

 

[Ducttape]

interestingly, also just recently published, a single IV injection of dex may be helpful short term.

http://www.ncbi.nlm.nih.gov/pubmed/25122642

Does a single dose of intravenous dexamethasone reduce Symptoms in Emergency department patients with low Back pain and RAdiculopathy (SEBRA)? A double-blind randomised controlled trial.
CONCLUSIONS:
In patients with LBPR, a single dose of intravenous dexamethasone in addition to routine management improved VAS pain scores at 24 h, but this effect was not statistically significant at 6 weeks. Dexamethasone may reduce EDLOS and can be considered as a safe adjunct to standard treatment.

Just to confuse people even more, Birdstrike's post comes from the Journal of Emergency Medicine. the link i just posted comes from Emergency Medicine Journal...

 

[nvrsumr]

I am sure everyone on this board has had a patient who has had short term benefit from oral steroids for radiculopathy. I have at least one a month who is going on vacation or something and I call in a medrol dose pack and they may or may not feel better for a week until I can get them in for an injection. I have zero issue injecting after they have completed a course. No big deal. Just like treating a rash.

 

[lobelsteve]

http://www.aafp.org/afp/2012/0215/p343.html

http://www.jfponline.com/index.php?id=22143&tx_ttnews[tt_news]=175980

http://rheumatology.oxfordjournals.org/content/early/2011/04/27/rheumatology.ker151.full

 

[SSdoc33]

I am sure everyone on this board has had a patient who has had short term benefit from oral steroids for radiculopathy. I have at least one a month who is going on vacation or something and I call in a medrol dose pack and they may or may not feel better for a week until I can get them in for an injection. I have zero issue injecting after they have completed a course. No big deal. Just like treating a rash.

exactly. stopgap measure.

if they are on a tapered course, just have them stop it for the injection

 

[bedrock]

exactly. stopgap measure.

if they are on a tapered course, just have them stop it for the injection

Agree.

I've seen this work plenty of times, but its not ideal. Often worthwhile as a stopgap, but I don't use it frequently.