• Ramsin M Benyamin, Ricardo Vallejo, Jeffery Kramer, and Roueen Rafeyan.
• Millennium Pain Center, Bloomington, IL 61701, USA. benyamin@millenniumpaincenter.com
• Pain Physician. 2008 Nov 1;11(6):917-20.

BackgroundSynthetic corticosteroids are commonly utilized in interventional pain management procedures. These substances have potential side-effects including psychological adverse events.ObjectiveWe describe a case of substance-induced psychotic disorder resulting from corticosteroids administration.DesignCase Report.MethodsWe describe a 67-year-old male that, six months prior to being consulted at our center, received a cervical epidural, 4 level medial branch blocks, 4 trigger point injections and a tendon injection in the shoulder all including corticosteroids all in one treatment session.ResultsApproximately 7 days following the multiple injections, the patient developed psychotic episodes including racing thoughts, anger, agitation, pressured hyperverbal speech and paranoia. The symptoms spontaneously resolved in approximately 7-10 days.DiscussionAlthough well known as a potential complication, corticosteroid induced psychosis secondary to interventional pain procedures have never been reported. We further discuss this potential side effect of utilizing corticosteroids and emphasize the need for guidelines regarding steroid utilization.

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