Medication treatment for neuromas
Oral non-steroidal anti-inflammatory medications (NSAIDs)
The majority of patients will start with a prescription for a non-steroidal anti-inflammatory medication. This type of medication is a prescription form of pills or capsules that are similar to over-the-counter anti-inflammatories such as Motrin or Aleve. While some patients prefer to use over-the-counter medications, prescription non-steroidal inflammatory medications usually work better. Some of these prescription anti-inflammatory medications are next generation such that they have less side effects on the gastrointestinal system. Examples of this type of medication are Celebrex and Mobic.
Topical non-steroidal anti-inflammatory medications (NSAIDs)
NSAIDs also come in topical ointments or creams that are applied to the skin over the neuroma. Although the penetration of the medication is much smaller than those taken orally, they can help to reduce inflammation of the neuroma.
Injectable steroids
In general, steroids act as very potent anti-inflammatory medications. Steroids can be given orally, intravenous, intramuscular, intraarticular (in a joint) or injected into a general area. For neuromas, usually we inject steroids around the neuroma / nerve. We usually use a type of steroid called an Acetate steroid, that is non-water soluble. This means that the body absorbs it very slowly. The steroid stays in the area where it is injected for up to 30 days. During this time, it works as a very potent local anti-inflammatory to actually shrink the neuroma in size. It also reduces inflammation and pain of the neuroma.
Unfortunately, there are side effects associated with steroid injections. One of the goals of the steroid injection is to shrink the size of neuroma however, it also affects the surrounding tissues and can cause atrophy and weakening. Adjacent to the neuroma are the metatarsal-phalangeal joints. Although it is rare, I have seen steroid injections cause atrophy, weakening and rupture of ligaments around these joints. For this reason, steroid injections are not always our first line of treatment. While they work very well, I usually try to avoid the risk of side effects by trying other less invasive treatments first. With this said, there have been many times where I did use a steroid injection on the patient’s first visit. Usually this is reserved for patients who have excruciating pain and want immediate relief. Also, I will give a steroid injection to some patients on my first encounter who have already received and failed other conservative treatment from other doctors.
Steroid injections should be used sparingly. As a rule, I will not give more than three steroid injections in any six-month period. Along with acetate steroids, there are also phosphate steroids. Phosphate steroids are water-soluble and therefore only stay in the area for a few days before they are absorbed and broken down by the body. Phosphate steroids can be as strong as acetate steroids, however, they do not last as long. In my experience, acetate steroids work much better than phosphate steroids. However, phosphate steroids have much less chance of atrophy and complications. Often, we will mix acetate and phosphate steroids together in one injection.
We also always mix local anesthesia such as lidocaine with our steroids. This allows dilution of the injection to allow for more volume to be injected in order to be distributed to a greater area of the injection site. It also makes injections of steroids less painful such that the local anesthesia starts working immediately to reduce the pain during the injection.
In our experience, there are ways to make steroid injections less painful to the patient. Many patients have told thus that our steroid injections for neuromas were surprisingly painless, or they had very little pain.
Oral steroids
Prescription oral steroids are not our first line of treatment usually. We reserve them for when other conservative treatments have failed. Oral steroids are strong anti-inflammatories and work very well for musculoskeletal type inflammatory conditions, including neuromas.
However, they may have side effects. With that said, when we do prescribe oral steroids, we use low doses and not for very long periods of time. Most side effects of oral steroids occur with prolonged usage. For a full list of side effects of oral steroids, you can easily find them with a simple Google search. The most common side effects of oral steroids in low dosage, and for short periods of time, occur with the gastrointestinal system. Similar to NSAIDs, oral steroids may cause abdominal pain, thinning of the stomach lining, and eventually stomach or intestine ulcerations. Oral steroids may diminish the immune system making one more prone to infections. Oral steroids can cause short-term water retention, bloating and weight gain.
Topical steroids
Steroids also come in topical ointments or creams that are applied to the skin over the neuroma. Although the penetration of the medication is much smaller than those taken orally, they can help to reduce inflammation of the neuroma.