role in controlling salt and water balance in the body and regulating carbohydrate, fat, and protein metabolism. When the body becomes stressed from infection, trauma, surgery, or emotional problems, the adrenal glands produce more cortisol, which helps the body to cope with the stress. When the stress disappears, cortisol production returns to normal. Cortisol also suppresses inflammation, which is the body’s normal response to outside invaders, such as bacteria (Hodgens & Sharman, 2023). Corticosteroids work by blocking the production of substances in the immune system (such as prostaglandins) that trigger allergic and inflammatory reactions. Some autoimmune disorders also trigger inflammation when they react to normal body tissue as if it were an outside invader. Corticosteroids are strong medications. Although they have proven to be helpful in treating many medical disorders, they have side effects that can be serious. Your patient should have discussed the potential risks and benefits with a physician before taking them (Hodgens & Sharman, 2023). Common side effects of corticosteroids include the following: ● Oral and intravenous ○ Suppression of the immune system, increasing likelihood for infection. ○ Bone loss, which may lead to or exacerbate osteoporosis. ○ Cartilage damage after repeated injections. ○ Acne. ● Ointments/drops ○ Eye infection. ○ Eye pain. ○ Gradual blurring or loss of vision. ○ Nausea/vomiting. ● Inhaled corticosteroids ○ Sore mouth or throat, hoarseness. ○ Coughing. ○ Thrush (fungus infection in the mouth). ○ Decrease in bone thickness. ○ High blood pressure in the eye or fluid buildup in the eye. ● Nasal spray corticosteroids ○ Increased chance of bruising. ○ Skin or muscle wasting. ○ Weight gain or fluid retention. ○ Decrease in bone density. ○ Damage to bones and bone cells (avascular osteonecrosis). ○ Increased blood pressure. ○ Increased risk of ulcer. ○ Increased risk of eye complications (e.g., glaucoma, cataracts). ● Topical corticosteroids ○ Skin blisters filled with blood. ○ Weight gain. ○ Mood swings. ○ Delayed growth (in children). ○ Blurred vision. ○ Frequent urination. ○ Increased thirst. ○ Increased appetite. ○ Indigestion. ○ Flushing of face or cheeks.
wringing techniques can result in bruising and inflammation of the tissues. Any manual therapy techniques that involve placing direct pressure or stress on tissue structures will need to be reviewed. Avoid heavy tapotement, passive forced stretching, muscle stripping, deep kneading, frictions, or joint mobilization. For tissues affected by topical steroid applications, exercise caution and modify the depth of pressure when working on tissues (Hodgens & Sharman, 2023). People who take corticosteroids for painful conditions such as osteoarthritis and rheumatoid arthritis may get them in the form of injections. For people with one painful joint (e.g., knee), an injection can provide pain relief and reduce swelling. Corticosteroids injected directly into a joint can concentrate the medication where it is needed and avoid potential problems such as an upset stomach. However, continued injections into specific joints may eventually damage the cartilage in the joint (Hodgens & Sharman, 2023). People taking corticosteroids should never stop taking them abruptly because they can experience serious side effects. A physician can provide a schedule for safely discontinuing the use of corticosteroids. Most corticosteroids are available only with a physician’s prescription. However, some low- strength topical creams are available over the counter (Hodgens & Sharman, 2023). Corticosteroids are extremely helpful as short-term relief for many chronic pain conditions. They are some of the most powerful medicines available to fight inflammation. However, long-term use of corticosteroids may lead to numerous side effects. Some of the strongest side effects are associated with the oral and intravenous forms of corticosteroids, which are used for pain. Physicians may try to minimize the side effects by prescribing as low a dose as possible for pain relief and by using corticosteroids for severe pain only (Hodgens & Sharman, 2023). Corticosteroids, like prednisone and prednisolone, are useful in their ability to inhibit production of inflammatory cytokines and chemokines, reducing the expression of inflammatory molecules. Hydrocortisone enemas are used to maximize effects in the targeted tissue of the rectum and sigmoid colon, and minimize systemic absorption (Hodgens & Sharman, 2023). Corticosteroids are used to treat moderate to severe active inflammatory bowel disease. Higher dosages risk significantly higher incidence of adverse effects. Oral dosage of prednisone or prednisolone is typically taken daily, once an individual responds to the initial therapy (usually a period of up to two weeks). Dosage is minimized to limit the risk of adverse effects. In very ill patients, intravenous administration may be common. IBD involving the sigmoid colon or rectum is primarily administered rectally to minimize systemic absorption (Hodgens & Sharman, 2023). Corticosteroids can have a wide variety of serious side effects—particularly when oral forms of the drug are taken for long periods of time. These include acne, weight gain, loss of bone density associated with osteoporosis, and decrease in immune response. Many types of medication can interfere with corticosteroids. Corticosteroids are different from the banned anabolic steroids taken by some athletes to enhance performance (Hodgens & Sharman, 2023). Corticosteroids are synthetic versions of the natural hormone cortisol, which is chemically related to the natural hormones produced by the body’s adrenal glands, located at the top of each kidney. Cortisol plays an important
○ Itching or burning skin. ○ Increased skin sensitivity. ○ Numbness in the fingers. ○ Increased chance of bruising. ○ Raised red spots on the skin.
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