The Effects of Glucocorticoids on Neuropathic Pain: A Review with Emphasis on Intrathecal Methylprednisolone Acetate Delivery

Rijsdijk, Mienke MD*; van Wijck, Albert J. M. MD, PhD*; Kalkman, Cornelis J. MD, PhD*; Yaksh, Tony L. PhD

doi: 10.1213/ANE.0000000000000161
Pain and Analgesic Mechanisms: Review Article
Continuing Medical Education

Methylprednisolone acetate (MPA) has a long history of use in the treatment of sciatic pain and other neuropathic pain syndromes. In several of these syndromes, MPA is administered in the epidural space. On a limited basis, MPA has also been injected intrathecally in patients suffering from postherpetic neuralgia and complex regional pain syndrome. The reports on efficacy of intrathecal administration of MPA in neuropathic pain patients are contradictory, and safety is debated. In this review, we broadly consider mechanisms whereby glucocorticoids exert their action on spinal cascades relevant to the pain arising after nerve injury and inflammation. We then focus on the characteristics of the actions of MPA in pharmacokinetics, efficacy, and safety when administered in the intrathecal space.

From the *Department of Anesthesiology, Pain Clinic, University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Anesthesiology, University of California San Diego, San Diego, California.

Accepted for publication November 4, 2013.

Funding: No funding.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to T. L. Yaksh, PhD, Department of Anesthesiology, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093. Address e-mail to tyaksh@ucsd.edu.

© 2014 International Anesthesia Research Society