Prednisone, a corticosteroid, closely resembles a steroid naturally made by the adrenal glands. Converted by the liver into a steroid, prednisone is used for a wide range of conditions. Primarily administered to reduce inflammation and suppress the immune system, few drugs have saved as many lives as prednisone. Some of the conditions prednisone treats include:
- Autoimmune diseases
- Inflammatory diseases
- Kidney diseases
- Organ transplant rejection
A client coming to see you with arthritis or chronic pain may be taking prednisone or one of its derivatives. As a reliable method of reducing inflammation, many pain management centers incorporate the use of prednisone into their treatment plans. With a reduction in inflammation, pain is typically reduced allowing additional therapies to be tolerated. A massage therapist must be aware of the implications of their clients on steroids for the following reasons:
- It is inappropriate to express disdain for this drug, as it may be bringing the client enormous relief and may discourage a client from taking it. Nobody should EVER stop using prednisone without proper physician approval and oversight.
- Many side effects (some serious) can result from taking this drug, particularly for those who have it prescribed for a long time.
Because the human body develops a dependency on prednisone, it must not be stopped without guidance from a doctor. A sudden withdrawal from prednisone may leave the body unable to synthesize natural corticosteroids, also known as adrenal suppression. This may cause symptoms such as extreme weariness, weakness, slowed movements, upset stomach, weight loss, changes in skin color, sores in the mouth, cravings for salt and may even be life threatening. Most physicians will monitor their patients as they progressively taper off prednisone. If you have a client feeling well enough to consider stopping their prednisone, explain how important it is that it be done gradually AND only under the care of a physician.
While steroids do decrease inflammation, they also decrease the formation of new bone, increase the breakdown of old bone and decrease the body’s absorption of calcium. Prolonged prednisone usage has been known to cause osteonecrosis; literally, bone death. Prednisone-induced osteonecrosis is especially common at the hip joint due to breakdown of the femoral head. This danger is why many people on long-term prednisone therapy simultaneously take another drug (such as Fosomax) to strengthen their bones. If a client demonstrates signs of osteoporosis or increasing hip discomfort while on long-term prednisone therapy, explain to them why they should review the side effects their medication may be exhibiting with their physician.
Immunosuppression is the act of reducing the activation or efficacy of the immune system. At first glance, reducing immune power may seem like an undesired phenomenon. However, deliberately induced immunosuppression can prevent the body from rejecting a transplant and is used to treat autoimmune diseases (such as rheumatoid arthritis), where the immune system attacks normal body tissue. Because prednisone is an immunosuppressant, it can render the body more susceptible to illness. Taking this steroid may make infections harder to treat. For this reason, clients should be encouraged to consult with their doctor as soon as possible if signs of an infection, such as sore throat, fever, sneezing or coughing are present.
Generalized Side Effects
A prednisone prescription requires constant feedback on its effects by the patient and subsquent fine-tuning by their physician to ensure its safety. The list of possible side effects is extensive and includes the following:
- Headache and dizziness
- Difficulty falling asleep or staying asleep
- Extreme changes in mood or personality
- Bulging eyes and increased perspiration
- Acne or thin, fragile skin
- Red or purple blotches or lines under the skin
- Slowed healing of cuts and bruises
- Increased hair growth
- Changes in the way fat is spread around the body
- Extreme fatigue and muscle weakness
- Irregular or absent menstrual periods
- Decreased sexual desire
Any of the above side effects should be discussed with a physician. More serious side effects include:
- Vision problems such as eye pain, redness or excessive tearing
- Sore throat, fever, chills, cough, or other signs of infection
- Depression or confusion
- Loss of contact with reality
- Muscle twitching or tightening
- Seizures or uncontrollable shaking of the hands
- Numbness, burning or tingling in the face, arms, legs, feet or hands
- Upset stomach or vomiting
- Irregular heartbeat
- Sudden weight gain
- Shortness of breath, especially during the night
- Dry, hacking cough
- Swelling of the eyes, face, lips, tongue, throat, arms, hands, feet, ankles or lower legs
- Difficulty breathing or swallowing
- Rash, hives or itching
These more serious side effects should be reported to a physician immediately.
Specific Massage Considerations
For clients taking prednisone, a gentle approach is often required. Prednisone can create a disturbance in fluid balance, resulting in abnormal swelling. Because the body’s circulatory system may be overloaded, a massage therapist should not attempt to dramatically shift the balance of fluid. Gentle work will minimize any dramatic fluid changes.
Another side effect of prednisone is the thinning and fragility of the skin. For a client with this manifestation, vigorous massage such as deep pressure or friction should be avoided to prevent tearing of the skin. Additionally, the immunosuppressant action of prednisone will hamper the skin’s healing ability.
Pros and Cons
Pain management specialists often use the reliable drug prednisone to control symptoms of chronic pain. Although most physicians convey the side effects and the need for patient-doctor communication, many people are not in close contact with their doctor. For healthcare professionals who typically see clients managing chronic pain, familiarity with prednisone’s pros and cons can facilitate your client’s reporting of important issues to their physician. This enforcement of communication serves your client by instilling their confidence in your knowledge and of course, by looking out for their safety.
Walton, Tracy, LMT, MS, Medical Conditions in Massage Practice, Part III: Interviewing for Medications, Massage Today, August 2005.
www.healthtalk.com, Ask the Doctor, Tina Chadha Bunch, MD, HealthTalk, October 2006.
www.ibdcrohns.about.com, Side Effects-Prednisone, Prednisone: Frequently Asked Questions, Steroid-Induced Osteoporosis, Amber J. Tresca, About, Inc., 2006.
www.nlm.nih.gov, Drug Information: Prednisone, National Institutes of Health, October 2006.
www.wikepedia.org, Prednisone, Wikimedia Foundation, Inc., 2006.