Damned if you do, Damned if you don’t
By; Sasha Klemawesch, MD
Here’s a doozy of a “Would-You-Rather”: Would you prefer continuing to deal with chronic unremitting knee pain, or would you rather have several days of unrelenting hiccups?
Those may seem totally unrelated, but actually, a little known (though not altogether uncommon) side effect of steroid injections is intractable hiccupping!
This was news to me too, but one of my colleague’s fell victim to it recently and was absolutely miserable for days. His knee was great! To the point he was actually able to resume jogging! But he said in the future, he’d take the long-term arthritis over the short-term hiccups.
Those two things seem so completely unrelated, I thought it couldn’t possibly be true that the knee injection caused his hiccups, but turns out there are myriad reports in the literature about this very phenomenon.
“Singulata” (aka the medical term for hiccups) are caused by a reflex arc involving various nerve pathways, the diaphragm musculature, and multiple neurotransmitters including dopamine, serotonin, GABA, et al. Anything that may dysregulate any one of those components has the potential to trigger hiccupping. And steroids, particularly high-Dose steroids are a known potential risk to upset that fine balance.
This unusual reaction is much better known in the fields of Neurosurgery and Rheumatology, both of which employ very high-dose/high-potency steroids more frequently in their day-to-day practice.
Luckily the reaction is self-limiting, and there are various medications that can help curtail the length of the misery such as Reglan, Baclofen, and Thorazine, though often it takes several trial and errors to find an efficacious one for each individual. At this time, no literature exists regarding the percent success rate of the old “drink out of the topside of the cup” though.