ALERT: The Dangerous Misuse of Oral Corticosteroids for Pain Management in Our Communities - A Community Pharmacy Practice Advisory

Community pharmacists across Nigeria are raising a critical alarm over an increasingly common and dangerous practice: the incessant and inappropriate use of oral corticosteroids for pain management, often prescribed by unqualified drug vendors to unsuspecting patients.

Medicines such as prednisolone and dexamethasone are powerful prescription-only drugs intended for specific inflammatory, autoimmune, and life-threatening conditions. Unfortunately, they are now routinely dispensed for arthritis pain, toothache, body pain, and general discomfort, sometimes for prolonged periods and without any form of medical supervision.

This trend represents a major public health risk.

---

Why This Practice Is So Worrisome

Oral corticosteroids:

• Are not analgesics

• Do not cure the underlying cause of pain

• Only suppress inflammation temporarily

• Carry serious dose- and duration-dependent adverse effects

When used continuously or inappropriately, they can cause more harm than the condition they were meant to relieve.

---

Case Reports From Community Pharmacy Practice

Case 1: Chronic Prednisolone Use and Delayed Knee Surgery

A woman in her early 50s with long-standing knee arthritis presented to our pharmacy. Further review of her medication history revealed she had been taking prednisolone 5 mg daily for approximately five years for pain relief.

This prolonged unsupervised steroid use resulted in multiple complications:

• Significant weight gain, increasing mechanical stress on her arthritic knee

• Development of hypertension, a well-documented adverse effect of chronic corticosteroid therapy

• Delay in her planned knee replacement surgery

Orthopedic evaluation revealed that prolonged steroid exposure had:

• Compromised bone quality and soft tissue integrity

• Increased the risk of poor wound healing and implant failure

• Raised concerns about postoperative infection

In essence, a medication meant to “help” her pain ended up worsening her overall condition and postponing definitive treatment.

---

Case 2: Steroids and NSAIDs for Toothache in a Young Adult

In another troubling case, a young lady in her 20s visited the pharmacy and was identified to be on the following combination for toothache:

• Dexamethasone 1mg

• Prednisolone 5mg

• Ibuprofen 400 mg

She had been taking this combination for three months, prescribed by a patent medicine vendor.

Upon counseling, she was shocked—but grateful—to learn the dangers of this therapy. She admitted to:

• Unexplained weight gain

• Prolonged use without any dental treatment

This case highlights multiple serious drug therapy problems.

---

Why This Drug Combination Is Dangerous

1. Duplicate Corticosteroid Therapy

Using dexamethasone and prednisolone together offers no therapeutic advantage but dramatically increases toxicity, including:

• Adrenal suppression

• Cushingoid features (weight gain, facial rounding)

• Increased infection risk

• Hormonal imbalance

---

2. Steroid + NSAID (Ibuprofen) Combination

The combination of corticosteroids with NSAIDs significantly increases the risk of:

• Peptic ulcer disease

• Gastrointestinal bleeding

• Gastric perforation, especially with prolonged use

Alarmingly, these complications can occur without warning symptoms, particularly in young patients who assume they are “too young” for serious side effects.

---

3. Masking the Real Problem

Toothache requires definitive dental care, not prolonged drug therapy. Steroids and NSAIDs may suppress pain temporarily while:

• Infection progresses

• Tissue damage worsens

• More invasive procedures become necessary

---

Common Dangers of Long-Term Oral Corticosteroid Use

Unsupervised or prolonged use can lead to:

• Hypertension

• Diabetes mellitus

• Weight gain and central obesity

• Osteoporosis and bone weakness

• Delayed wound healing

• Increased susceptibility to infections

• Adrenal suppression, making sudden drug withdrawal dangerous

• Worsening of joint degeneration over time

These risks apply to both young and older adults.

---

Key Messages 

• Oral corticosteroids are not routine pain medicines

• Quick relief does not equal safety

• Persistent pain requires proper diagnosis, not stronger drugs

• Steroids should never be used long-term without specialist supervision

• Multiple steroids should never be combined

• Medicines prescribed by unqualified vendors can be life-altering in the wrong way

---

Recommendations and Call to Action

For Patients

• Avoid accepting steroid medicines without seeing a qualified healthcare professional

• Seek proper evaluation for chronic pain or dental problems

• Do not reuse or refill steroid prescriptions without review

For Pharmacists

• Actively screen for steroid misuse

• Provide firm but compassionate counseling

• Refuse inappropriate dispensing of prescription-only medicines

• Document and escalate unsafe practices

For Regulators and Professional Bodies

• Strengthen enforcement against unqualified drug vendors

• Intensify public education on the dangers of steroid misuse

• Support pharmacists as frontline patient safety advocates

For Healthcare Providers

• Promote safer, multimodal pain management approaches

• Emphasize definitive treatment over symptomatic suppression

• Prescribe steroids only when clearly indicated and for the shortest duration possible

---

Conclusion

The misuse of oral corticosteroids in community settings is no longer anecdotal—it is systemic and dangerous. From delayed surgeries to avoidable chronic diseases, the consequences are real and growing.

Community pharmacists remain a critical line of defense. Through vigilance, education, and ethical practice, we must continue to protect our patients from harm.

No pain relief is worth permanent damage.