Steroids - specifically anabolic steroids - have gotten a bad reputation lately because of their inappropriate use by athletes and youngsters wishing to add muscle bulk and increase endurance.

But when used appropriately and under a doctor's supervision, corticosteroids - different from anabolic steroids - are powerful anti-inflammatory medications that comprise an important tool in the pain-relief arsenal.

Many times, especially for rheumatoid arthritis and other autoimmune conditions, inflammation is a major source of pain. Steroids can provide significant relief by reducing this inflammation, as well as helping to control the underlying immune disease.

Inflammation also plays a key role in other types of pain, such as an attack of intense, low-back pain in someone with long-standing disc herniation. Sometimes a flare of pain is due to injury or overuse of a body part, and sometimes the specific cause isn't known. In these situations, a short course of steroids can calm down the inflammation and thereby reduce the pain.

Beyond their ability to reduce inflammation, steroids also work directly on the brain's chemistry to elevate mood and reduce the sensation of pain. So, even in the absence of inflammation, steroids can very quickly make you feel better - often within minutes or hours.

For pain control, the two most common ways of administering steroids are by mouth (systemic therapy, affecting the entire body) and by injection (local therapy, affecting the area around the injection). Systemic therapy can be done at home with a prescription, and is called for when multiple areas of the body are hurting.

A short course of steroid pills can be taken to relieve a temporary condition; a long course can be used to control a chronic condition. Local therapy is more appropriate for short-term treatment of pain involving just one or a few areas. It usually requires a needle to get the medicine to the proper place.

If the effect of steroids is less pain and a better mood, what's not to like? Why not just put everyone with pain and inflammation on these powerful meds? Because, unfortunately, steroids also have a long list of possible side effects, some of them quite severe:

• Most people taking steroids retain fluid and put on extra fat - and that fat tends to stay put even after the steroids are stopped.
• Because steroids suppress the body's immune function - a good thing when you're treating an underlying autoimmune disease - they increase the risk of infection.
• When taken by mouth, steroids are even more likely to cause gastritis than the NSAIDs.
• Systemic steroids increase blood glucose levels, which may cause or worsen diabetes.
• Rarely, steroids can stop blood supply to a joint (especially the hip), causing a painful degeneration called avascular necrosis.
• Used long term, steroids reduce bone density, increasing the risk of fracture.
• Long-term steroids use also suppresses normal adrenal gland function, which in turn can seriously hinder your ability to respond to severe physical or emotional stressors.

In sum, steroids are strong medications that provide rapid, effective pain relief - and they need to be used cautiously to maximize safety. They carry many risks, some of which can be reduced by using the lowest possible dose and minimizing the number or duration of treatments.

You shouldn't refuse steroids if your doctor recommends them, but I suggest you maintain a healthy respect for their power and avoid using them excessively.