Steroids (oral) I

Anyone who saw Lebron James and the Cleveland Cavaliers third game against the Atlanta Hawks can easily appreciate the level of pain James was in at the end of the game. I will continue writing about pain control this week.

Now that I have thoroughly review non-steroidal anti-inflammatory medication, you may be asking what a steroid truly is. When we hear the word “steroids” we often think of Mark McGuire, Barry Bonds, or other high profile athletes stripped of their fame due to the illegal use of steroids. The medical perspective, however, is much different. Chiropodists such as Stephen Hartman prescribe these drugs commonly to treat inflammation.

Hydrocortisone is the main steroid from which the potency of all others are compared. Cortisone is the only one weaker, which is 80% as potent. Prednisone, prednisolone, methylprednisolone, and triamcinolone are 4 to 5 times stronger than hydrocortisone. Betamethosone and Dexamethosone are the most powerful steroids at 20-30 times the potency of hydrocortisone.

Potency cannot be ignored when considering the profound side effects of chronic steroid use. Chiropodists/podiatrists are especially aware of these side effects because so many of them fall within the realm of what we treat every day. For example, a high percentage of our patient base is composed of diabetic patients. Steroids can elevate blood sugar, actually causing diabetes in some cases, and exacerbating it in patients with previously diagnosed diabetes.

Another important side effect a chiropodist/podiatrist will always consider is the decrease in wound healing associated with steroid use. This is an important consideration for our wound care and surgical patients. Also, steroids can cause tendon rupture, with the Achilles tendon being the most commonly effected. Furthermore, steroids can cause osteoporosis. This is an important consideration for anyone we treat, especially the elderly. Steroids also cause weight gain and immunosuppression.

Steroids are safe if given in the acute setting and small doses. Few medications work so well when it comes down to calming a painful bout of tendonitis or plantar fasciitis, for example. However, patients should be aware of the potential to develop serious side effects with chronic steroid use.