Oral Cortisone for Nerve Pain with Inflammation

Dear Dr. Blake

I wonder if you would be able to answer a quick question for me?  I'm here in the UK and have been suffering from neuromas in my feet (2 in each foot) for around 17-years.  The right foot was operated on in 2012 and now I have 2 stump neuromas (both >1cm).  The neuromas in the LT foot are also >1cm.

In an attempt to avoid further surgery I have had radiofrequency ablation, cryosurgery, alcohol injections, steroid injections etc.  None of which have really worked that well, though the steroids do help a bit.  The surgeon I have been seeing is reluctant to offer any more steroid injections because he is concerned about foot pad atrophy (he is not the surgeon who operated on the RT foot). 

My neuromas are causing me a lot of problems at the moment, though I can still cycle (which is a great passion of mine).  Later this year I plan to ride from Moscow to London, then at the end of the year, proceed with surgery.

My question is whether you think a course of oral prednisolone might be worth a try, just to get me through this exacerbation of symptoms/

Thanks so much for your help

Kind regards

Dr. Blake's comment: A 6 to 8-day course of oral cortisone to drive down inflammation is okay. Remember no strenuous activity for the duration of the meds and another equal time, including cycling! It can only be done once every 6 months! Rich

Two good articles:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737790/

This article above is great in cautioning it not to be used in skeletally immature athletes and limiting the total dose under 400 mg. But, there is no mention of not exercising while on it or for the next 6-8 days. This helps prevent bone problems like osteonecrosis, stress fractures, etc. From what I have read, these tips are anecdotal but an important precaution. One rheumatologist believes that any form of cortisone should be limited to once per month, with oral once per 6 months. The article below talks about the prednisone burst dosage and how wired people feel the first 4 of 8 days. Rich

http://www.drblakeshealingsole.com/2010/12/oral-cortisone-king-of-anti.html

This I wrote this article 8 years ago, I would add not to be used if you have Vit D deficiency or Low Bone Density, or any problems that cortisone may affect (slight Adrenal Insufficiency). 

Severe Plantar Fasciitis and Oral Cortisone: Email Advice

Dear Dr. Blake.
Thank you so much for posting and blogging about Plantar Fasciitis /Bursitis.
It has been very helpful for me.
In my hospital in Amsterdam i had all the treatings. I do not
have to name it again.. I told my orthopedic doktor about oral cortisone and he was
at least suprised. He never heard of oral cortisone with Plantar Fasciitis.

http://www.drblakeshealingsole.com/2010/12/oral-cortisone-king-of-anti.html

He gave me a cortisone injection.
No pain relief. Yes for 4 day.s..

At the moment i.m in Marbella/Spain.
Also here i have had, Fysiotherapy, laser. insoles...
no happy end . Pain and pain.. of course I used also ibuprofen, paracetamol,
naproxen and so on and so on.
I.m desperate.. 

Reading your artikel about Oral Cortisone..
And the Prednisone Burst.
I want please to ask you.
You are working with sport men and woman.
I.m a fragil woman from 70 years old and my weight is 60 kg.

I think that for every person the quantity of oral prednisone can be different.
So in my case what do you advice me ?? How much is responsable for me, as an old fragil woman to take ?

Dr Blake's comment: Please ask a pharmacist  if age and weight are a factor. I have not come across that. 

Considering the fact that I also have a severe pulmonary fibrose IPF, and i.m on PIRFENIDONE.
Thats  a very heavy and strong medicin.
The regular dose of Pirfenicone = 9 pils a day, but I can only handle 6 pils a day.

https://en.wikipedia.org/wiki/Pirfenidone

Dr Blake's comment: Your doctor treating the fibrosis, and the pharmacist mixing the drugs, would be the best at commenting if a 8 day course of oral cortisone would be contra-indicated. 
 
I would be so happy to hear from you and listen to your advice.
Yesterday I started with 2 pils of 5 mg (togehter) and it was too strong already.
My body was shaking..and sweating and so on..
Dr Blake's comment: That is probably your answer not to take. Sorry.  If you can get an MRI or Ultrasound, see if you do not have a plantar fascial tear. The treatment would be a removable boot for 12 weeks but you do not need the medicine then. Good luck . Dr Rich Blake

Yes i hope you have a little time to answer me.
Thank you so much Dr. Blake and I wish you all the best..
LOve.