Corticosteroid induced psychosis in the pain management setting

Pain Physician. Nov-Dec 2008;11(6):917-20.

Abstract

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.

Design: 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.

Discussion: 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.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / adverse effects*
  • Aged
  • Aggression / drug effects
  • Aggression / physiology
  • Anger / drug effects
  • Anger / physiology
  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents / adverse effects
  • Cervical Vertebrae / drug effects
  • Domestic Violence
  • Drug Administration Schedule
  • Humans
  • Injections, Epidural / adverse effects
  • Injections, Epidural / standards
  • Male
  • Methylprednisolone / administration & dosage
  • Myofascial Pain Syndromes / drug therapy
  • Neck Pain / drug therapy*
  • Nerve Block / adverse effects
  • Nerve Block / standards
  • Paranoid Personality Disorder / chemically induced
  • Paranoid Personality Disorder / physiopathology
  • Psychoses, Substance-Induced / etiology*
  • Psychoses, Substance-Induced / physiopathology
  • Time Factors
  • Triamcinolone / administration & dosage

Substances

  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents
  • Triamcinolone
  • Methylprednisolone