Application of Glucocorticoids in Minimally Invasive Interventional Pain Management: Chinese Expert Panel-Based Guideline: Expert Panel of Special Training Project on Pain Management of National Health Commission Capacity Building and Continuing Education Center.

Abstract

Background: Glucocorticoids (GCs) are widely used in clinical practice. Through minimally invasive intervention technology, GCs act on lesions accurately. This route of administration is superior to others. However, GCs are often applied irrationally, and serious adverse reactions frequently ensue.

Objectives: The aim of this review is to provide an expert consensus for the application of GCs in minimally invasive interventional-administration routes and thereby develop a consistent philosophy among the many diverse groups interested in the use of GCs.

Setting: The Expert Panel of Special Training Project on Pain Management of National Health Commission Capacity Building and Continuing Education Center.

Methods: We set up the Expert Panel of Special Training Project on Pain Management of National Health Commission Capacity Building and Continuing Education Center from various specialties and groups and performed the study of GC-related objectives and vital issues. The center reviewed the literature on the use, effectiveness, and adverse outcomes of GCs in accordance with evidence-based medicine principles, evaluated the quality of evidence by synthesizing existing literature, and utilized grading for recommendation.

Results: The grading recommendations for the application of GCs were formed to standardize said application. The center recommended that the principles of minimally invasive intervention of GCs be as follows: 1) Suspending GCs is not recommended for the cervical and thoracic epidural block or the radicular block if imaging monitoring is unavailable; 2) For drug compatibility, drugs other than normal saline, local anesthetics, and GCs are not recommended; 3) For treatment of epidural and selective radicular blocks within 6 months, intermediate- and long-acting GCs should not be used more than 3 times, while short-acting GCs should not be used more than 5 times; 4) GCs can be injected intraarticularly once every 3 months for up to 2 consecutive years. The frequency of intraarticular GC injections should be determined based on the severity of the patient's conditions and symptoms, as well as the preferences of the medical staff and patient; 5)GCs are not recommended for sympathetic blocks. In addition, the expert team made detailed grading recommendations for the indications, contraindications, minimally invasive interventional-administration routes, and specific operations of GCs.

Limitations: Lack of high-quality RCTs.

Conclusions: The expert consensus was established on the basis of comprehensive review of the literature and consensus among the panelists. Consequently, different minimally invasive routes of GC administration recommend different doses and courses to standard the use of GCs.