Pain Caused by Steroid Withdrawal

Steroids are classified as androgen steroid and corticosteroid. Corticosteroid is available as glucocorticoid and mineralocorticoid. Glucocorticoid has been used as anti-inflammatory medication to treat severe inflammation not responding to NSAIDs. Corticosteroid (glucocorticoid) is known as magic medicine and extensively used for various medical conditions. Inflammatory and non-inflammatory chronic diseases treated with corticosteroids are rheumatoid arthritis, autoimmune diseases, asthma, inflammatory bowel syndrome, and many other painful conditions of the body.

Pain Caused by Steroid Withdrawal

Steroids have proved to be very effective in relieving various painful conditions but steroids also carry with them the inherent risk of quite significant side effects and moreover if steroids are stopped abruptly then it may give rise to various painful withdrawal symptoms. Abrupt withdrawal of steroid even after 3 weeks of treatment causes withdrawal in elderly patients.1 In this article, we will discuss about how steroids can increase the very painful condition it is supposed to relieve.

What Does Steroid Actually Do In Human Body?

Stimulate Cortisol Secretions-

  • Steroids are shown to simulate cortisol, which is an antiinflammatory hormone secreted by adrenaline gland and found naturally in the body.

Anti-inflammatory Properties-

  • Corticosteroid drugs like betamethasone, prednisone, and prednisolone have been used for past several years to treat various painful inflammatory diseases.
  • Corticosteroid has also been used to improve symptoms of inflammatory chronic bowel diseases like ulcerative colitis.

Side Effects of Steroids

  • The chronic use of steroids tends to cause quite significant side effects as a result of changes in the balance of the natural production of the hormone in the body.
  • Side effects like osteoporosis can restrict activities.

Corticosteroid Withdrawal-

  • Now, we need to understand what happens when steroids are abruptly discontinued or dosage is reduced rapidly in few days.
  • The moment the dosages of the steroids are decreased an individual starts to experience withdrawal symptoms, which sometimes causes muscle and joint pain.

Hence physicians prefer to use steroids for the shortest amount of time possible and they do not stop it abruptly.

Can The Steroid Withdrawal Symptoms Be Prevented?

  • No. The withdrawal symptoms cannot be prevented if cortisone pills or injections are stopped abruptly.
  • In few cases even slow withdrawal of corticosteroid pills may not stop withdrawal symptoms.2
  • Symptoms of withdrawal can be less intense if withdrawal of corticosteroid pills or injection is slow.
  • Symptoms are less intense if corticosteroid is withdrawn slowly following long-term corticosteroid treatment.
  • Researchers are of the belief that the production of corticosteroids is under the control of a phenomenon called as "Feedback Mechanism" which involves the brain, the pituitary gland, and the adrenal glands. This is called Hypothalamic-Pituitary-Adrenal Axis or the HPAA.
  • Pituitary gland secretes a corticosteroid stimulating hormone when corticosteroid hormone is less in the body. Corticosteroid stimulating hormone stimulates adrenaline gland to secrete corticosteroid hormone so that there is adequate hormone present in the body.
  • Long-term treatment of corticosteroid suppresses pituitary gland and pituitary gland discontinues secretion of corticosteroid stimulating hormone.
  • It takes time for pituitary gland to start secretion of hormone, which influences adrenaline gland to secrete steroids. Initial secretion is slow and quantity secreted is inadequate.
  • Hence, it is always suggested not to stop use of steroids abruptly and it needs to be tapered. So there is enough synthetic corticosteroid in the body in addition to lower rate of secretion of the biological steroid by adrenal gland.
  • Adrenal gland compensates the deficiency by secreting biologic cortisone and adds to synthetic cortisone. Quantity of cortisone secretions improves with time. Thus, slow withdrawal of cortisone pills or injections prevents cortisone withdrawal symptoms.

Why Withdrawal Symptoms Are Observed In Few Cases despite Slow Withdrawal of Cortisone Pills or Injections?

  • Unfortunately, even timely tapering of steroids cannot prevent the withdrawal symptoms from occurring.
  • Researchers are of the opinion that Steroid Withdrawal is multifactorial including physiological response to dependence on steroids.
  • It is assumed that every individual undergoing steroid therapy is bound to have a diminished HPAA function.
  • Research data suggests in few cases pituitary gland is unable to secrete stimulating hormone.3

It is pretty difficult to ascertain how an individual may react to a flare up of the underlying disease after discontinuing the steroids and hence restarting the steroids looks to be the only resolution to the issue.

Symptoms Of Steroid Withdrawal

The symptoms of a Steroid Withdrawal may mimic other medical problems. Some of the steroid withdrawal symptoms are:

  • Severely painful joints and muscles
  • Muscle spasms
  • Weakness
  • Fatigue
  • Weight loss
  • Loss of Appetite
  • Hypotension
  • Hyperglycemia

Remedies To Cope Up With Pain Due To Steroid Withdrawal Symptoms

Pain Associated With Steroid Withdrawal-

  • For Steroid Withdrawal symptom of pain, an individual can take pain medications like Advil up to 800 mg dosage to cope up with the pains in combination with Tylenol.
  • One needs to make sure that after taking Advil one needs to wait for about a couple of hours before taking the Tylenol.

Nocturnal Pain-

  • Tylenol PM can be used. There may be times, when complete relief may not be obtained even with this combination but for that muscle relaxants and topical pain relievers can be used but for pain due to Steroid Withdrawal an individual needs to gut it out and one thing is for sure that eventually the pain will pass away.

Antihistaminic-

  • Benadryl is prescribed when withdrawal is associated with hives or histamine induced symptoms.

The individual first needs to consult a doctor before starting on the above mentioned medications.

References:

1. Corticotherapy withdrawal in older people. [Article in French],

Retornaz F1, Boullu-Ciocca S2, Farcet A3, Oliver C3.

Geriatr Psychol Neuropsychiatr Vieil. 2013 Dec;11(4):361-6.

2. Evolving adrenal insufficiency.

Roy A1, Bhattacharjee R, Goswami S, Thukral A, Chitra S, Chakraborty PP, Meher D, Ghosh S, Mukhopadhyay S, Chowdhury S.Indian J Endocrinol Metab. 2012 Dec;16(Suppl 2):S369-70.

3. Adrenal insufficiency after glucocorticoid withdrawal in children with rheumatic diseases.

Huber BM1, Bolt IB, Sauvain MJ, Flück CE.

Acta Paediatr. 2010 Dec;99(12):1889-93.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: October 3, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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