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Evaluation

Clinical Session Proposals

Pain and Spine Medicine

Session Name: Concurrent Sessions

Concerns With Steroid Use In Patients With Musculoskeletal and Spine Problems: What Do We Do About The Current Overuse of All Forms of Steroids?

Friday, November 17, 2023
3:15 PM – 4:30 PM CT
Location: CC 217-219
In-Person Live Stream On Demand

    Session Director(s)

  • James W. Atchison, DO

    Chair of PMR
    Mayo Clinic Jacksonville
    Jacksonville, Florida

    Disclosure(s): No financial relationships to disclose

    • Faculty(s)

  • Christopher J. Standaert, MD

    Associate Professor, Vice Chair, Dept PM&R
    University of Pittsburgh Medical Center
    pittsburgh, Pennsylvania

    Disclosure(s): No financial relationships to disclose

  • Christine Hunt, DO (she/her/hers)

    Assistant Professor, Pain Medicine
    Mayo Clinic College of Medicine
    Jacksonville, Florida

    Disclosure(s): Abbott: Research Grant (includes principal investigator, collaborator or consultant and pending grants as well as grants already received) (Ongoing); Nevro: Research Grant (includes principal investigator, collaborator or consultant and pending grants as well as grants already received) (Ongoing)

Session Description: This session will propose that many patients are currently being exposed to higher than recommended doses of steroids, and receiving them in many forms including oral, intra-articular injections, and spinal injections by introducing actual case examples. the presenters will introduce cases that represent this and then review the medical risks associated with all steroids and noted complications of high utilization of steroids. There will be discussion about the relative mEq in comparison for oral, intra-articular, and epidural steroid injections and the differences in types of steroids. We will then review the amount of steroid use in an individual per year and potentially her lifetime.
Why is this session needed? With limitations of pain medications in many forms, there has been a significant increase in steroid use for musculoskeletal and spine problems. Much of this use does not follow any recommended guidelines or best practices/medical evidence for the injuries or pain complaints. This session is needed to remind physiatrist of the proper indications for steroid use, review the potential risks and complications of steroid use, and make us all aware of pain more attention to the comprehensive management of the patient including taking a thorough history of all other treatments performed in addition to our and recommended treatments.

Was this session previously presented at the Annual Assembly?: No, not that I am aware of. Each year at the meetings, there is debate about specific spine procedures and indications versus contraindications but no overall discussion on the total steroid use.

Learning Objectives:

  • discuss with patients and other colleagues who are providing treatment to the patient. the general recommendations through national guidelines for steroid use in acute and chronic low back pain and other musculoskeletal problems
  • communicate the known medical risks of steroid use in each patient based on known medical issues and other medication use, and apply these standards to the individual contemplating further injections
  • utilize knowledge of relative steroid potency for each type of administration and form of glucocorticoids, and how this impacts the annual use and lifetime cumulative use risk for each patient.