Corticosteroid induced psychosis in the pain management setting.
BACKGROUND
Synthetic corticosteroids are commonly utilized in interventional pain management procedures. These substances have potential side-effects including psychological adverse events.


OBJECTIVE
We describe a case of substance-induced psychotic disorder resulting from corticosteroids administration.


METHODS
Case Report.


METHODS
We describe a 67-year-old male that, six months prior to being consulted at our center, received a cervical epidural, 4 level medial branch blocks, 4 trigger point injections and a tendon injection in the shoulder all including corticosteroids all in one treatment session.


RESULTS
Approximately 7 days following the multiple injections, the patient developed psychotic episodes including racing thoughts, anger, agitation, pressured hyperverbal speech and paranoia. The symptoms spontaneously resolved in approximately 7-10 days.


CONCLUSIONS
Although well known as a potential complication, corticosteroid induced psychosis secondary to interventional pain procedures have never been reported. We further discuss this potential side effect of utilizing corticosteroids and emphasize the need for guidelines regarding steroid utilization.
Benyamin
Ramsin M
RM
Millennium Pain Center, Bloomington, IL 61701, USA. benyamin@millenniumpaincenter.com
Vallejo
Ricardo
R
Kramer
Jeffery
J
Rafeyan
Roueen
R
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D000374:Aggression / Q000187:drug effects / Q000502:physiology; D000786:Anger / Q000187:drug effects / Q000502:physiology; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects; D002574:Cervical Vertebrae / Q000187:drug effects; D017579:Domestic Violence; D004334:Drug Administration Schedule; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects / Q000592:standards; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D009209:Myofascial Pain Syndromes / Q000188:drug therapy; D019547:Neck Pain / Q000188:drug therapy*; D009407:Nerve Block / Q000009:adverse effects / Q000592:standards; D010260:Paranoid Personality Disorder / Q000139:chemically induced / Q000503:physiopathology; D011605:Psychoses, Substance-Induced / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors; D014221:Triamcinolone / Q000008:administration & dosage
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D014221:Triamcinolone; D008775:Methylprednisolone