Singer Brian, Chaimovitz Dovid, Bucek Thomas, Dayon Eli, Abbott-Korumi Aimee, Spatz Moshe, Makkapati Tejaswi, Petrosyan Hayk, Delavaux Laurent
Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute at Hackensack Meridian Health, Edison, NJ 08820, USA.
Rosalind Franklin University of Medicine and Science, Chicago, IL 60064, USA.
Medicina (Kaunas). 2025 May 21;61(5):936. doi: 10.3390/medicina61050936.
Effective multidisciplinary pain management involves an in-depth knowledge not only of diagnosis and treatment but of how interventional procedures affect patients across all health domains. One of the most common pharmacological tools utilized in patients suffering from chronic pain disorders is corticosteroids. Corticosteroids are leveraged for their anti-inflammatory properties across a wide range of disorders. This review examines the role of corticosteroids and pain management with a specific focus on their metabolic impact regarding glucose metabolism. Corticosteroids have been shown to increase gluconeogenesis, resulting in reduced insulin sensitivity and an impaired peripheral glucose uptake. These varied responses to corticosteroids are especially concerning given the high prevalence of diabetes mellitus in chronic pain patients. There is well-documented evidence of not only transient hyperglycemia but emerging literature on prolonged glycemic disturbances that may have a greater effect on patients than previously recognized. A review of the available literature reveals variations in hyperglycemia depending on corticosteroid type, dose, and various patient-specific factors. Some research does suggest that lower corticosteroid dosages can provide similar therapeutic benefits and potentially reduce glycemic aberrations. Given the current evidence, clinicians should closely monitor patients' hemoglobin A1C levels when determining the risks and benefits of an interventional procedure and consider alternative pain management strategies when appropriate. Future research should focus on optimizing corticosteroid selection and dosing to balance the safety, particularly in diabetic or prediabetic patient populations.
有效的多学科疼痛管理不仅需要深入了解诊断和治疗方法，还需要了解介入程序如何在所有健康领域影响患者。在患有慢性疼痛疾病的患者中使用的最常见药物工具之一是皮质类固醇。皮质类固醇因其在广泛疾病中的抗炎特性而被利用。本综述研究了皮质类固醇在疼痛管理中的作用，并特别关注其对葡萄糖代谢的代谢影响。已表明皮质类固醇会增加糖异生，导致胰岛素敏感性降低和外周葡萄糖摄取受损。鉴于慢性疼痛患者中糖尿病的高患病率，对皮质类固醇的这些不同反应尤其令人担忧。不仅有关于短暂高血糖的充分文献证据，而且有关于长期血糖紊乱的新文献，这些紊乱可能对患者的影响比以前认识到的更大。对现有文献的综述揭示了高血糖的差异，这取决于皮质类固醇的类型、剂量和各种患者特定因素。一些研究确实表明，较低剂量的皮质类固醇可以提供类似的治疗益处，并可能减少血糖异常。鉴于目前的证据，临床医生在确定介入程序的风险和益处时应密切监测患者的糖化血红蛋白水平，并在适当的时候考虑替代疼痛管理策略。未来的研究应侧重于优化皮质类固醇的选择和剂量，以平衡安全性，特别是在糖尿病或糖尿病前期患者群体中。
