Background: Synthetic corticosteroids are commonly utilized in interventional pain management procedures. These substances have potential side-effects including psy- chological adverse events. Objective: We describe a case of substance-induced psychotic disorder resulting from corticosteroids administration. Design: Case Report Methods: We describe a 67-year-old male that, six months prior to being consulted at our center, received a cervical epidural, 4 level medial branch blocks, 4 trigger point injections and a tendon injection in the shoulder all including corticosteroids all in one treatment session. Results: Approximately 7 days following the multiple injections, the patient devel- oped psychotic episodes including racing thoughts, anger, agitation, pressured hyper- verbal speech and paranoia. The symptoms spontaneously resolved in approximately 7-10 days. Discussion: Although well known as a potential complication, corticosteroid induced psychosis secondary to interventional pain procedures have never been reported. We further discuss this potential side effect of utilizing corticosteroids and emphasize the need for guidelines regarding steroid utilization. Key words: Steroid, corticosteroid, psychosis, psychotic disorder Pain Physician 2008; 11:6:917-920 Case Report Corticosteroid Induced Psychosis in the Pain Management Setting From: 1 Millennium Pain Center, Bloomington, IL; 2 Illinois State University, Department of Biology, Normal, IL; 3 University of Illinois College of Medicine at Urbana- Champaign, Urbana, IL; 4 University of Illinois , College of Medicine at Peoria, Department of Cancer Biology and Pharmacology, Peoria, IL; and 5 Rush University Medical Center, Chicago, IL. Address correspondence: Ramsin Benyamin, MD Millennium Pain Center 1015 S. Mercer Ave. Bloomington, Illinois, 61701 E-mail: benyamin@millenniumpaincenter. com Disclaimer: There was no external funding in the preparation of this manuscript. Conflict of interest: None. Manuscript received: 04/04/2008 Accepted for publication: 10/13/2008 Free full manuscript: www.painphysicianjournal.com Ramsin Benyamin, MD 1,2,3 , Ricardo Vallejo, MD, PhD 1,2 , Jeffery Kramer, PhD 1,2,4 , and Roueen Rafeyan, MD 5 www.painphysicianjournal.com Pain Physician 2008; 11:917-920 • ISSN 1533-3159 T he performance of common interventional pain procedures that utilize corticosteroids is rising (1). Adverse reactions in response to the administration of synthetic corticosteroids such as methylprednisolone and triamcinolone can include dermatologic conditions, peptic ulcer formation, weight gain, hyperglycemia, and Cushing’s syndrome. More detailed descriptions of the spectrum of physiologic side effects have been previously published and are outside the scope of this case report (2,3). Psychiatric symptoms have also been reported and these can vary from mild mood changes to full blown psychosis (4,5). Despite the lack of reports in the pain literature, the current case emphasizes the potential of corticosteroid induced psychosis following multiple interventional pain procedures performed in one session. A 67-year-old, Caucasian male was referred to our pain center for evaluation and management of chronic neck pain as a result of a fall 7 years prior. His