Dr. Fudin, can you explain methylprednisolone, dexamethasone, the blood brain barrier, and if these have a place in managing chronic pain? What is the difference between methylprednisolone and prednisone.
Prednisone is a miracle for me, but I’m aware of damage from long term use. Is there a “safe” low dose for any corticosteroid?
Also, is there a class of medication that crosses the blood brain barrier, and would those be more effective for pain in spine diseases such as Arachnoiditis, Stenosis, Degenerative Disc Disease?
Jacqueline, The Blood Brain Barrier (BBB) is simply various layers of tissue around the brain and spinal cord that prevent passage of various chemicals across that barrier. fat soluble substances more easily pass thru this barrier, and many drugs require various carrier proteins to pull them thru the BBB. Anti-inflammatories including steroids and NSAIDs both pass the BBB. Much, if not most of their activity is outside the central nervous system at the sight where inflammation occurs, specifically by blocking prostaglandins locally. Methylprednisolone, prednisone, and other similar mineralocorticoid steroids vary in their activity and pharmacokinetics. See http://www.nadf.us/downloads/adrenalhormone.pdf, which delineates them by Equivalent Glucocorticoid Dose, Anti-Inflammatory, Mineralocorticoid, Peak Plasma concentration, Duration of Action.