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Friday, December 17, 2010

Oral Cortisone: The King of Anti-Inflammatory Medication

     When symptoms are clearly inflammatory, and you are having a hard time reducing the pain level, think about a short course of oral cortisone. This is called a Cortisone Burst, or a Prednisone Burst, since prednisone is one of the most common drugs to use for this purpose. This can also be used when you have chronic, mysterious pain and you are unclear if it is inflammatory. Oral cortisone over an 8 day course in this case will be therapeutic, but also diagnostic. The health care provider will need then to find the source of the inflammation. Remember, cortisone will reduce swelling which is one source of pain. Cortisone will not reduce the pain of broken bones or damaged nerves.

     I have used oral cortisone the same way for 30 years with good results. Most of the patients have at least temporary, and sometimes quite long lasting,  80-90% pain relief. They are very grateful for some relief. And, in the real world, patients present with the acute problem you are treating them with, and also other pains. The secondary benefit of oral cortisone is the relief it gives to these other areas. I remember a patient with severe plantar fasciitis I was treating with contrast bathing, icing, ibuprofen, physical therapy, etc, to name a few, that got poison oak. The ER doc placed him on lotions, plus an 8 day tapering course of prednisone. Not only did the symptoms of the poison oak resolve, but it completely knocked out the plantar fasciitis. That plantar fasciitis was better after only 3 days on the prednisone, and never returned once the prednisone ended. Of course, he had all the other treatments of plantar fasciitis on board (splints, orthotics, taping, stretching, etc.) I kept him icing twice daily for several months longer. You can only give oral cortisone every 6 months.

     Oral cortisone can give great results if the pain you are treating is inflammatory. But, some patients have little to no pain relief, if there symptoms are not just related to inflammation. I find the patients who get no relief from this drug very unfortunate, but very diagnostic. A negative response like that sends me looking elsewhere for the source of their pain.

     Of course, oral cortisone must be given by a doctor, after weighing in any relevant health concerns. Some patients are not candidates for this drug. I have had several patients allergic to this medication. It is important to note that our bodies make 15-18mg of cortisone naturally every day. This is how I write for a Prednisone Burst:
                                   Prednisone  5 mg
                                       Disp: 54
                                    Sig: 3 tablets po 4 times daily for 2 days
                                            2 tablets po 4 times daily for 2 days
                                            2 tablets po 2 times daily for 2 days
                                            1 tablet po 2 times daily for 2 days
                                   No Refills

If you do the math, I give 60 mg for 2 days, then 40 mg for 2 days, then 20 mg for 2 days, and finally, 10 mg for 2 days. It is while taking the 10 mg that the body starts making it's own again. The last 2 days are crucial doses, since the first 6 days have shut off the body's production. Stopping, for any reason, this drug before you complete the full 8 days should only be done on doctor's advice, since it can produce an adrenal crisis (does not sound good!!) I have never had a patient not finish the course. 90 % are very glad that they did it, but most are wired (even very difficult falling to sleep) for the first 4 days. So it is used when appropriate, but I thought it is such an important tool at times, that you should know about it. Since it is a naturally occurring drug, I would say that used correctly it is very safe.


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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.