Enhancing the Relative Safety of Intentional or Unintentional Intrathecal Methylprednisolone Administration by Removing Polyethylene Glycol

Abstract

We believe that by decreasing the PEG concentration using our method, MPA-related complications will potentially be reduced, and this should be considered in patients with postherpetic neuralgia refractory to other treatments who might be candidates for repeated intrathecal injections.

Pharmacology for the Interventional Pain Physician

“…44 Polyethylene glycol, the vehicle used in methylprednisolone and triamcinolone, can decrease the compound action potential of the A, B, and C fibers. 97 Interestingly, the intrathecal injection of the vehicle in dogs showed minimal histologic changes, whereas methylprednisolone resulted in a dose-dependent intrathecal inflammatory reaction. In addition, the concentration of PEG in the vial can be significantly decreased by inverting the vial for 1 to 2 hours and aspirating and using the steroid component.…”

“…Injectable Bone Cements Powder) 75% w/w methylmethacrylate-styrene-copolymer, 10% w/w barium sulfate, 15% w/w polymethyl methacrylate (Liquid)97.4% v/v methylmethacrylate (Monomer) 2.6% v/v N,N-dimethyl-p-toluidine, 75±15 ppm hydroquinone HV-R Medtronic, Kyphon Northridge, CA, United States (Powder) 68% w/w methylmethacrylate-styrene-copolymer, 30% w/w barium sulfate, 2% w/w benzoyl peroxide (Liquid) 99.1% v/v methylmethacrylate (Monomer) 0.9% v/v N,N-dimethyl-p-toluidine, 75 ppm hydroquinone Palacos R Biomet Orthopedics, Inc. Warsaw, IN, United States (Powder) 81.8% w/w methyl acrylate, methylmethacrylate, 14.9% w/w zirconium dioxide, 0.78% w/w benzoyl peroxide, 2.4% chlorophyll (Liquid) 96% v/v methyl methacrylate (Monomer) 2.0% v/v N,N-dimethyl-p-toluidine, 0.40 mg chlorophyll DePuy 1 DePuy Orthopedics Inc. Warsaw, IN, United States (Powder) 88.85% w/w polymethyl methylmethacrylate, 9.1% w/w barium sulfate, 2.05% w/w benzoyl peroxide (Liquid) 98.18% v/v methylmethacrylate (Monomer) 0.82% v/v N,N-dimethyl-p-toluidine, 25 mg hydroquinone Osteobond Zimmer Inc. Warsaw, IN, United States (Powder) 88.75% w/w polymethyl methylmethacrylate-styrene, 10% w/w barium sulfate, 0.0125% w/w benzoyl peroxide (Liquid) 97.3% v/v methylmethacrylate (Monomer) 2.7% v/v N,N-dimethyl-p-toluidine, 80 ppm hydroquinone -di-tert-butyl-p-cresol (Reinforcing components) silane treated combeite glassceramic (Na 2 O-CaO-P 2 O5-SiO 2 ), silane treated bariaboroa lumino-silicate glass (Bao-B 2 O 3 -Al 2 O 3 -SiO 2 ), silane treated amorphous silicon dioxide (SiO 2 ), methacryloxypropyltrimethoxysilane Powder) 72.3% w/w tetracalcium phosphate, 27.7% w/w dicalcium phosphate anhydrous (Fluid) 0.25 mol/L phosphate solution and distilled water-Powder) α-tricalcium phosphate, tetracalcium phosphate, dicalcium phosphate, and hydroxyapatite (Liquid) chondroitin sodium sulfate, sodium succinate, and water Reproduced from Lieberman I, Togawa D, Kayanja MM. Vertebroplasty and kyphoplasty: filler materials.…”

The efficacy and safety of corticosteroids in the treatment of acute and chronic pain

“…In 2011, Candido et al proved that by inverting a vial of commercially-prepared methylprednisolone and waiting for the polyethylene glycol to separate from the steroid, one could significantly reduce the concentration of polyethylene glycol in a given injection. 10 The significance of this was reiterated in 2014, when Knezevic et al showed that a decreased concentrations of polyethylene glycol resulted in a significantly smaller percentage of apoptotic dorsal root ganglion sensory cells in rats. 11 This study highlighted the potentially dangerous side-effects of added preservatives.…”

Do Corticosteroids Still Have a Place in the Treatment of Chronic Pain?

“…This study demonstrated a linear dose-response relationship between increased concentrations of either PEG or myristyl-gamma-picolinium chloride or their combination and cytotoxic effects on dorsal root ganglia (DRG) sensory neurons in rat models. Candido et al (2011) demonstrated a method of decreasing the concentration of polyethylene glycol (PEG) preservative in the commercial formulation of methylprednisolone acetate (MPA) injection. This study showed that by inverting the vial with a commercial formulation of MPA for about 2–4 h, prior to aspirating its contents, an average of 85% of PEG per vial would be removed ( Candido et al, 2011 ).…”