The use of Corticosteroids in Nerve Blocks- A Recent Review

Podcast Show Note Summary:

Episode Title: "New Guidelines for Corticosteroid Injections in Chronic Pain Management"

This podcast is a discussion about the recent review article

Use of corticosteroids for adult chronic pain interventions: sympathetic and peripheral nerve blocks, trigger point injections - guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, the International Pain and Spine Intervention Society, and the North American Spine Society

In this episode, we dive into the recently published guidelines on the use of corticosteroid injections for managing chronic pain, developed by the American Society of Regional Anesthesia and Pain Medicine, along with several other prominent pain societies. These guidelines address the safety and efficacy of corticosteroid injections for sympathetic and peripheral nerve blocks, as well as trigger point injections.

Key Discussion Points:

1. Background and Need for Guidelines:

   • Overview of potential adverse events from corticosteroid injections, such as increased blood glucose levels, decreased bone mineral density, and suppression of the hypothalamic–pituitary axis.
   • Importance of using lower doses of corticosteroids, which studies have found to be just as effective as higher doses.

2. Development of the Guidelines:

   • The guidelines were approved by multiple pain societies and structured into three categories: sympathetic and peripheral nerve blocks, joint injections, and neuraxial injections.
   • Extensive literature review and consensus-building through a modified Delphi process.

3. Key Recommendations:

   • The addition of corticosteroids to local anesthetics is recommended for certain nerve blocks, such as the greater occipital nerve block for cluster headaches and ilioinguinal/iliohypogastric nerve blocks for post-herniorrhaphy pain.
   • Corticosteroid addition is not recommended for sympathetic nerve blocks, greater occipital nerve blocks for migraines, and pudendal nerve blocks for pudendal neuralgia.
   • Imaging guidance (ultrasound or fluoroscopy) improves the safety and accuracy of certain procedures.

4. Efficacy and Safety:

   • Detailed analysis of various studies on the effectiveness of corticosteroid injections for different types of chronic pain.
   • Discussion on the minimal benefit of corticosteroids in trigger point injections and the potential risks associated with their use.

5. Clinical Implications:

   • How these guidelines can assist clinicians in making informed decisions regarding corticosteroid use in chronic pain management.
   • Emphasis on the need for personalized treatment plans based on individual patient characteristics and clinical data.

6. Future Directions:

   • Identification of gaps in the current research and the need for well-designed studies to further assess the benef