Pain, General | February 7, 2015 | Author: The Super Pharmacist
Cortisone is a corticosteroid. These are a class of drugs that are structurally similar to some natural hormones (i.e. steroid hormones) and regulatory molecules found in the body. Cortisone is released by the adrenal gland in response to stress. It is similar to cortisol, (or hydrocortisone) another adrenal hormone. This molecule may affect many physiological processes in the body, due to its close resemblance to many steroid hormones in the body.
These may include:
Therefore, the administration of exogenous (or from external sources) cortisone may have profound effects on psychological state, bodyweight control, and response to infection of patients who receive this steroid as a treatment for a condition or disorder.
Cortisone is sometimes taken orally, but intravenous or intramuscular injection is also indicated for some healthcare applications. As this may result in a more effective and systemic exposure to cortisone, patients may need to be more aware of the risks and side-effects associated with this drug. If the long-term use of cortisone injection is necessary, these are typically reduced in dose according to the minimum concentration needed to produce effective relief from symptoms.
Cortisone injections may be recommended for many conditions and disorders. These may include:
Adrenal Insufficiency: Intramuscular injections of cortisone may be used to address conditions in which the adrenal gland is damaged or its function is impaired. Adrenal defects may also result from disorders of the the hypothalmic-pituitary-adrenal (HPA) axis, such as Addison's disease.
Joint Pain: Cortisone injection is often indicated for cases of pain resulting from damage to cartilage and bone-on-bone friction. This is often associated with inflammation, which may be inhibited by corticosteroid administration. The steroids are delivered via injection directly into the joint. However, this treatment may only be effective in the short term. A study including 54 patients with hip pain accompanied by cartilage damage found that cortisone injection resulted in significant decreases in pain rating scores immediately after the procedure. However, after 14 days, pain scores had significantly increased again, and only 20 patients reported statistically significant pain relief. At six weeks post-injection, only three patients reported significant decreases in pain. A trial assigning 40 patients with shoulder pain to either oral cortisone or cortisone injections found that the injections were associated with increased patient satisfaction and shoulder movement compared to the group given oral cortisone, although both treatments had a similar significant effect on pain.
Rheumatoid Arthritis: This is an inflammatory condition that also affects joints, but may result in additional damage to organs in severe cases. Corticosteroid injections are a common form of therapy for patients with this condition.
Heel Pain: Most forms of heel pain are related to the wear and tear of the thick band of tissue (the plantar fascia) located between the bone of the heel and the skin on the bottom of the foot. In severe forms, the bone may come into direct contact with this skin. Cortisone injections are associated with pain relief for patients with this condition. However, this also has a short duration of effect.
Multiple Sclerosis: This is an episodic (or regularly recurrent) condition in which pain may be the result of damage to the membranes normally present around nerves. Cortisone injections may reduce this pain at its onset.
The use of steroid medications may result in a number of side-effects and adverse events. The risk of these may increase with long-term and/or high dose administration. These may include:
Gastrointestinal Disorders: Steroid therapy is associated with the risk of damage to the gastrointesinal tract, which may increase in response to prolonged use. Common forms of this adverse event are ulcers, or erosions of the inner layers of gastric linings. This may affect regions of the tract such as the duodenum.
Weight Gain: Cortisone intake may be associated with increases in appetite and increased body fat. Up to 70% of patients may experience increased hunger with increases in bodyweight.
Sleep Disturbances: Corticosteroid therapy may result in changes in the physiological regulation of sleep and wake cycles. These may include insomnia and the impaired ability to maintain sleep.
Psychiatric Conditions: The use of corticosteroids such as cortisone may increase the risk of emotional or behavioural disorders. Some estimates indicate that approximately 3% of patients receiving corticosteroids may develop psychoses. Up to 4% develop anxiety disorder or depressive symptoms. These risks may be associated with the duration of steroid therapy and variations in dose over time.
Insulin Resistance: Cortisone and other similar corticosteroids are associated with increased risks of insulin resistance, a condition which may be a precursor of adult onset diabetes (or diabetes type 2). This effect may be known as 'steroid diabetes'.
Cognitive Defects: Corticosteroid therapy has been associated with memory deficits. However, these are reversible. The risk of these defects is not thought to be associated with the amounts of cortisone injected. This treatment has also been linked to other problems such as impaired concentration and attention.
Arthritis: Steroid therapy may result in the increased risk of arthritis. In rare cases, joint disease associated with cortisone injection may be septic, or caused by infection. There are also isolated reports of the development of necrosis in a joint following a cortisone injection.
Osteoporosis: Long-term corticosteroid use may be associated with increased risks of bone density loss (i.e. osteoporosis). Patients taking long-term courses of cortisone injections may require prophylactic measures such as vitamin D and/or calcium supplementation, and treatment with drugs such as bisphosphonates.
Pancreatitis: This is an inflammation of the pancreas, another known possible complication of corticosteroid injection. A case report documented two separate attacks of pancreatitis in the same patient two years apart. Both were associated with cortisone injection.
Paediatric Side-effects: The complications as above are mainly relevant to adult patients. However, children with conditions treated with steroid therapy may also be at risk of adverse effects. Research indicates that over 70% of child patients receiving corticosteroids may develop attention deficits, irritability, hyperactivity or insomnia.
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