Re: The Burton Report...EPIDURAL STEROID INJECTIONS of the LUMBAR SPINE

From: anonymous (anonymous@medispecialty.com)
Fri Dec 6 01:16:27 2002


Where can I get a copy of the Kenalog data sheet referred to in your message?

This drug is "not recommended for administration via the epidural route" according to the data sheet provided by its manufacturers, Bristol Myers Squibb (Wallingford, Connecticut, U.S.A

At Sun, 5 May 2002, Helen Dynda wrote: >
>The Burton Report...EPIDURAL STEROID INJECTIONS of the LUMBAR SPINE
>
>http://www.burtonreport.com/InfSpine/AdhesArachEpiInjLumbSpine.htm
>
>Since the withdrawal of oil-based myelography Depo-MedrolÒ and Depo-MedroneÒ have become the principal cause of clinically significant adhesive arachnoiditis in the Western world. Depo-MedrolÒ (and other similar suspensions) are being administered epidurally as routine off-label and ill-advised, treatments for back pain. The rationale given for the use of these suspensions is that their main ingredient, methylprednisolone, is an anti-inflammatory agent.
>
>Although basically true in concept suspensions of synthetic glucocorticoids are effective anti-inflammatory agents but they also contain preservatives such as polyethylene glycol, known better as a anti-freeze in car cooling systems. Other preservatives include alcohol. Both ethylene glycol and alcohol are well-recognized toxic agents if introduced into the sub-arachnoid space.
>
>Wood (1) studied the effects of injections of methylprednisolone acetate into rat sciatic nerves. Nerves treated with either the steroid or its vehicle showed damage, including collagen (scar) formation and demyelination.
>
>The manufacturers Depo-MedrolÒ (Upjohn Pharmaceutical Co., Kalamazoo, Michigan, U.S.A.) stated in 1981 that "we would advise against the epidural/ extradural routes of administration because of possible adverse reactions". However, this specific recommendation was withdrawn from the data sheet in 1997.
>
>Kenalog (triamcinolone suspension) is another steroid used in epidural injections. This drug is "not recommended for administration via the epidural route" according to the data sheet provided by its manufacturers, Bristol Myers Squibb (Wallingford, Connecticut, U.S.A.) As with any "off-label" use of a drug or device their application is dependent upon the individual doctor’s discretion and clinical judgment. It is the individual physician who then takes personal responsibility for this.
>
>In both the U.S. and England epidural steroid injection (ESI) in the treatment of back pain is practiced extensively and by a variety of clinicians including general practitioners, anesthesiologists, radiologists and specially trained physiotherapists.
>
>The current associated literature on Depo-MedrolÒ states that it is contraindicated for intrathecal administration and that it contains benzyl alcohol, which is potentially toxic when administered locally to neural tissue. Most patients who have had adverse effects from the epidural suspensions say they would not have allowed the injection if they had been provided with informed consent and had known that these drugs were not licensed for this particular application.
>
>[TO FINISH READING THIS ARTICLE, GO TO: http://www.burtonreport.com/InfSpine/AdhesArachEpiInjLumbSpine.htm ]


Enter keywords:
Returns per screen: Require all keywords: