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Pain and Spine Medicine

Prospective Observational Cohort Study to Evaluate Associated Short Term Steroid Related Side Effects on the Central Nervous System After Epidural Steroid Injections

Thursday, November 16, 2023

    Co-Author(s)

  • NE

    Nafis B. Eghrari, Other

    Medical Student
    Case Western Reserve University School of Medicine
    Cleveland, Ohio

  • chong H. kim, MD

    Professor
    MetroHealth/Case Western Reserve University
    Cleveland, Ohio

    • Primary Author(s)

  • SS

    Suzanna Shermon, DO

    Resident
    MetroHealth System/Case Western Reserve University PM&R Program
    Cleveland, Ohio

    • Co-Author(s)

  • Andrew C. Olsen, DO

    Resident
    MetroHealth System/Case Western Reserve University PM&R Program
    Cleveland, Ohio

  • AC

    Anil Chakravorty, Other

    Medical Student
    Case Western Reserve University School of Medicine
    Cleveland, Ohio

Background and/or Objectives: The central nervous system (CNS), including the hypothalamus, contains steroid receptors. Steroid administration can, thus, impact emotions, mood, concentration, and energy levels. We investigate the prevalence of these symptoms after epidural steroid injection (ESI) and examine if a psychiatric history exacerbates symptomatology.

Design: Prospective cohort study.

Setting: Academic teaching hospital.

Participants: 69 subjects undergoing ESIs.

Interventions: Psychiatric histories were collected from the subjects’ charts. Subjects were contacted at 24 hours and one week after their procedures. They were asked about the following symptoms compared to their baseline: sad mood, increased energy, restlessness, irritability, decreased concentration, anger, anxiety, and trouble sleeping.

Main Outcome Measures: Psychiatric history, subjective feelings of sad mood, increased energy, restlessness, irritability, decreased concentration, anger, anxiety, and trouble sleeping.

Results: 69 patients participated in this study; 31 had a psychiatric history (such as depression, anxiety). On day 1 for those with a psychiatric history, the most common symptoms were restlessness (55%), trouble sleeping (48%), and irritability (29%). On week 1 follow-up for those with a psychiatric history, the most common symptoms were restlessness (32%), irritability (19%), trouble sleeping (26%), and anxiety (16%). On day 1 follow-up for those without a psychiatric history, the most common symptoms were increased energy (34%), restlessness (26.3%), and trouble sleeping (32%). Week 1 follow-up for this subgroup showed that the most common symptoms were trouble sleeping (23.6%) and increased energy/restlessness (16% each).

Conclusions: Restlessness and trouble sleeping are the most common CNS symptoms after an ESI at one day and one week after the procedure, regardless of psychiatric history. However, these symptoms, along with others, are more likely in those with psychiatric history.