Pugchief, I'd love to hear if this idea works for your patients. I expect it would help if pain is inflammatory in origin, but won't do much for neuropathic pain. Cheap to try though. If it's going to work it should get results within a few hours.
I took prednisone 60mg, which is a high dose. Typically, the taper is 60mg x 2 days, then 40mg x 2 days, then 20mg x 2 days, then off. There is also a 6 day Medrol dose pack (methylprednisolone), easy to prescribe. I was planning to taper over 3 days: 60mg, then 40mg, then 20mg, then off. 6 days may be overkill, but it's fine to stop the taper at any point, no actual need for slow withdrawal if treating for less than 2 weeks.
The infection risk for a short pulse is minimal. But, it would be prudent to make sure you're not dealing with persistent active infection. Obviously if the patient worsens after starting prednisone you'll have a good idea that it's an infection, so warn them to call right away if this happens.
Other things to be aware of:
- insomnia: patient should take prednisone in the AM, not PM. Some people may have trouble sleeping after the first dose, regardless.
- if your patient is diabetic: prednisone increases serum glucose. When treating with prednisone patient should do qid fingersticks.
- if recent history of GI bleed: probably shouldn't do this. Some MDs automatically prescribe an antacid along with the prednisone. Ibuprofen is no better in this regard though.
- history of stroke, heart attack, or major psychiatric illness especially with psychosis or anxiety: I'd refrain from prednisone in these cases also.
BTW it's 10:30 pm and STILL almost no pain. Awesome.
Root canals
Moderator: Global Moderator
Re: Root canals
I've obviously heard of steroids for chronic inflammation, also for widespread, severe inflammation (e.g., as an adjunct to chemotherapy), but never for short-term, traumatic-type inflammatory pain. You've got me curious why you would bring out the big guns when a run-of-the-mill opiate and a couple of days' vacation would (presumably) do the job. I know virtually nothing about these drugs, but anything that knocks out your adrenals to the point where it requires tapering after a single dose? Geez. Sounds dangerous.
I had a cat, bless her heart, who was on prednisone long-term for IBD. A very common disease in cats, but very debilitating, and probably very painful, as it progresses. Initially she was given a steroidal concoction called depo-medrol, which is an injectable preparation in a gooey base that causes it to diffuse into the bloodstream over a three-month period. Some time later, a veterinary critical care specialist discontinued that drug with the comment, "The stuff ought to be outlawed." For several years thereafter, my cat was on oral prednisone. However, I was never warned about the need for tapering, and I'm sure that I discontinued and resumed it many times, trying to keep her on the least aggressive, yet still effective, protocol. You know, you do your absolute best to protect these helpless little creatures; then you find out something like this. God I hate vets.
Sorry to hear you've been through all this, WiseOne.
I had a cat, bless her heart, who was on prednisone long-term for IBD. A very common disease in cats, but very debilitating, and probably very painful, as it progresses. Initially she was given a steroidal concoction called depo-medrol, which is an injectable preparation in a gooey base that causes it to diffuse into the bloodstream over a three-month period. Some time later, a veterinary critical care specialist discontinued that drug with the comment, "The stuff ought to be outlawed." For several years thereafter, my cat was on oral prednisone. However, I was never warned about the need for tapering, and I'm sure that I discontinued and resumed it many times, trying to keep her on the least aggressive, yet still effective, protocol. You know, you do your absolute best to protect these helpless little creatures; then you find out something like this. God I hate vets.
Sorry to hear you've been through all this, WiseOne.
Re: Root canals
Maddy, did you get up on the wrong side of the bed this morning?? I wouldn't have imagined you'd try to argue that prednisone is more dangerous than narcotics so early in the day :-)
In this case, I figured out that the problem causing the pain was swelling in a limited space that was taking a long time to resolve (weeks). That's something that is best addressed by steroids, while NSAIDs and narcotics only mask the symptoms and have more side effects if they're used for that time period. And narcotics just weren't an option for me anyway - too sedating. So the steroid was the right tool for the job.
In this case, I figured out that the problem causing the pain was swelling in a limited space that was taking a long time to resolve (weeks). That's something that is best addressed by steroids, while NSAIDs and narcotics only mask the symptoms and have more side effects if they're used for that time period. And narcotics just weren't an option for me anyway - too sedating. So the steroid was the right tool for the job.
Re: Root canals
Sorry, I didn't mean to sound snarky. I'm genuinely interested in why you'd choose prednisone over a narcotic in this instance. Perhaps you assume that I know more about these drugs than I do.WiseOne wrote:Maddy, did you get up on the wrong side of the bed this morning?? I wouldn't have imagined you'd try to argue that prednisone is more dangerous than narcotics so early in the day :-)
In this case, I figured out that the problem causing the pain was swelling in a limited space that was taking a long time to resolve (weeks). That's something that is best addressed by steroids, while NSAIDs and narcotics only mask the symptoms and have more side effects if they're used for that time period. And narcotics just weren't an option for me anyway - too sedating. So the steroid was the right tool for the job.
Indeed my (lay person's) assumption is that steroids generally are a more dangerous class of drugs than narcotics. The dangers of narcotics seem to be all about their addictive potential, and I've never known any normal, squared-away person who comes home from the dentist with a script for Tylenol #3s to have that problem. To the contrary, the people whose lives have been ruined through dependency on opiates tend, curiously, to be simultaneously engaged in thirty-nine other addictive methods of ruining their lives. Also, there seems to be an agenda at play when the studies citing the prevalence of narcotic abuse in the general population include people who on a single occasion took a T#3 from a neighbor for a headache.
Ironically, I was thinking last night (quite tongue in cheek) that it would be just like the feds, fixated as they are on the issue of opiods, to issue guidelines putting every malingerer with a sore back on steroids.
Re: Root canals
At risk of straying off topic to answer Maddy's excellent questions...
There's no such thing as a 100% safe drug. Every drug has what's called an "LD50" i.e. a dose that's lethal to half the lab animals (usually mice) that are given it.
The word "dangerous" is a bit misleading I think. You really mean "side effects", and they're much more common with narcotics than with prednisone or NSAIDs. Mainly it's sedation, respiratory suppression, unpleasant GI symptoms, and a potentially life-threatening withdrawal syndrome if taken continuously for long enough (even if there's not an addiction per se). Then there's NSAIDs which most of us think of as harmless. One of the most common reasons for liver transplant in the US is Tylenol overdose, and for some people, an overdose can happen even if they follow instructions on the bottle. And if you take ibuprofen for a long enough time, you risk a whole host of side effects including rebound headaches (which I'm experiencing right now, what a lovely surprise), gastric bleeding, and liver or kidney damage that is often irreversible.
So I guess you could consider all of them dangerous, just in different ways and depending very much on how much you take and for how long, pre-existing medical problems, and individual susceptibility. I really don't like narcotics because they make me nauseated plus I can't afford to be sedated for even a day, let alone a week. On the other hand, some people might do fine on them and tolerate them better than NSAIDs. As far as prednisone goes, yes there are people who have had bad side effects like hyperglycemia, opportunistic infections, and significant weight gain, but that's typically from long term use.
BTW yes, sometimes Medrol packs are prescribed for back pain, depending on the cause. It's very effective for acute herniated discs, sciatica, and nerve entrapment syndromes. Also, prednisone is one of the very few drugs known to be safe in pregnancy, so it gets used quite a bit in that setting for everything from migraines to allergies.
I should mention that these aren't the only classes of meds out there that can be used for pain control, but I think I've now written enough on the topic. G'night!
There's no such thing as a 100% safe drug. Every drug has what's called an "LD50" i.e. a dose that's lethal to half the lab animals (usually mice) that are given it.
The word "dangerous" is a bit misleading I think. You really mean "side effects", and they're much more common with narcotics than with prednisone or NSAIDs. Mainly it's sedation, respiratory suppression, unpleasant GI symptoms, and a potentially life-threatening withdrawal syndrome if taken continuously for long enough (even if there's not an addiction per se). Then there's NSAIDs which most of us think of as harmless. One of the most common reasons for liver transplant in the US is Tylenol overdose, and for some people, an overdose can happen even if they follow instructions on the bottle. And if you take ibuprofen for a long enough time, you risk a whole host of side effects including rebound headaches (which I'm experiencing right now, what a lovely surprise), gastric bleeding, and liver or kidney damage that is often irreversible.
So I guess you could consider all of them dangerous, just in different ways and depending very much on how much you take and for how long, pre-existing medical problems, and individual susceptibility. I really don't like narcotics because they make me nauseated plus I can't afford to be sedated for even a day, let alone a week. On the other hand, some people might do fine on them and tolerate them better than NSAIDs. As far as prednisone goes, yes there are people who have had bad side effects like hyperglycemia, opportunistic infections, and significant weight gain, but that's typically from long term use.
BTW yes, sometimes Medrol packs are prescribed for back pain, depending on the cause. It's very effective for acute herniated discs, sciatica, and nerve entrapment syndromes. Also, prednisone is one of the very few drugs known to be safe in pregnancy, so it gets used quite a bit in that setting for everything from migraines to allergies.
I should mention that these aren't the only classes of meds out there that can be used for pain control, but I think I've now written enough on the topic. G'night!
Re: Root canals
Coming to this website is a root canal.
Re: Root canals
Don, you're welcome to not read (and more than welcome to not comment on) threads that don't interest you.