Complex regional pain syndrome (CRPS) may be treated with several types of therapies and medications. The condition can vary greatly between patients, as well as the types of treatments that are effective for each case. For this reason, several types of treatment may be used in conjunction when attempting to alleviate pain symptoms or heal CRPS and RSD patients. Corticosteroids may be a recommended form of treatment for some CRPS patients.
What Are Corticosteroids?
Corticosteroid is a general term referring to a group of steroid hormones. Corticosteroids reduce activity within the immune system and decrease inflammation in the body. Some of these hormones are naturally-produced in the adrenal cortex, or the adrenal gland’s outer portion. Corticosteroids may also be synthetically produced. Synthetically-produced corticosteroids may be designed to resemble cortisol, a natural hormone in the body.
Types of Corticosteroids
There are several types of corticosteroid treatments depending on the patient’s condition. Treatment deliveries include local treatments such as joint injections, inhalers, drops for the eyes and ears, and skin creams. Systemic corticosteroids may be administered orally, intravenously (IV), and intramuscularly (into the muscle). CRPS treatment typically utilizes a systemic corticosteroid regimen. Corticosteroids which may be used for CRPS include prednisone, prednisolone, cortisone, and methylprednisolone.
How Corticosteroids Work
Corticosteroids work by blocking certain immune system chemicals that initiate the inflammation process within the body. They may also disrupt the function of white blood cells. White blood cells play a key role in targeting and destroying foreign bodies such as bacteria and viruses that enter the body. For this reason, corticosteroids may make patients susceptible to infection.
Corticosteroids and Inflammation
Corticosteroids are helpful in alleviating inflammation that is not related to the natural healing process. When the body experiences infection, it produces infection-fighting antibodies. These antibodies prevent infection from spreading while killing the cause of the infection. In the process, inflammation occurs, causing the area to become warm and swollen. In cases of skin, redness will also occur. While inflammation is necessary for healing, the body may become inappropriately inflamed when there is no infection. This is the case for CRPS and other inflammatory conditions.
CRPS Benefits of Corticosteroids
Steroids are known for their powerful anti-inflammatory properties. They may therefore be an effective treatment, especially during early or acute CRPS phases. During these phases, inflammation is typically more significant. Several corticosteroid studies provide evidence of symptom relief for CRPS patients. It is important to note that while these results are promising, treatment efficacies will vary among patients.
Corticosteroid Study Results
A study was conducted on 36 patients who developed shoulder-hand syndrome after a hemiplegic stroke. These patients were treated with low-dose corticosteroid therapy for two to three months of the stroke. After 10 days of oral corticosteroid therapy, 31 of the 36 patients were nearly free of symptoms. Another small study indicated that a 12-week corticosteroid treatment regimen of 10 milligrams of prednisone three times daily produced a 75% improvement in RSD patients.
This study also showed that after two weeks, patients showed an increase in met-enkephalin. Met-enkephalin is a naturally-occurring opioid in the body. This opioid produces analgesic, or pain-killing effects. It is therefore suggested that corticosteroids may also contribute to pain relief in addition to inflammation reduction.
Corticosteroid Side Effects
Patients should be aware of possible corticosteroid side effects before beginning treatment. Corticosteroids are typically prescribed for short-term use, such as in cases of acute inflammation. Scientific research shows that the ratio of risks to benefits may be questionable when considering long-term corticosteroid use. This means that in some cases, long-term steroids may pose more risks than benefits.
Side effects of corticosteroids may include, but are not limited to, the following:
- Increased blood pressure
- Increased blood sugar, which may cause or worsen diabetes
- Elevated eye pressure, which may lead to glaucoma
- Cataracts, or clouding of the eye lens
- Osteoporosis and bone fractures
- Easy bruising, thinned skin, and slower wound healing
Pollard, Catherine. “Physiotherapy management of complex regional pain syndrome.” New Zealand Journal of Physiotherapy 41.2 (2013): 65+. Academic OneFile. Web. 8 Mar. 2014.
Lee, John, and Paul Nandi. “Early aggressive treatment improves prognosis in complex regional pain syndrome.” The Practitioner Jan. 2011: 23+. Expanded Academic ASAP. Web. 8 Mar. 2014.