Intraspinal steroids: history, efficacy, accidentality, and controversy with review of United States Food and Drug Administration reports

Epidural Local Anesthetic Plus Corticosteroid for the Treatment of Cervical Brachial Radicular Pain: Single Injection Versus Continuous Infusion

“…Despite some contention over epidural steroids for the treatment of lower back pain and other radicular syndromes, 26,27 their efficacy is generally accepted 10,28 and their use has been shown to be common and consistent with suggested guidelines. 29 The observed efficacy of these drugs is probably related to their multiple short-term effects including anti-inflammatory and immunosuppressive activity, 3,8,[15][16][17] and the probable inhibition of neurotransmission within C-fibers.…”

Pertinacious prescription of practice paradigms: The ethical burden of coercive clinical guidelines

“…Several well-controlled studies have demonstrated that epidural radicular injection of steroid/local anesthetic/ radiocontrast cocktail, a treatment contraindicated by instruction of the manufacturer, produces no better result than placebos [25]. Risks of complication are significant.…”

Safety Assessment and Pharmacokinetics of Intrathecal Methylprednisolone Acetate in Dogs

“…In fact, a variety of adverse events have been reported in association with intrathecal corticosteroids, including chemical meningitis, transverse myelitis, cauda equina syndrome, lumbar radiculitis, intractable headache, urinary retention, and adhesive arachnoiditis. 1,3 The explanations for these adverse events remain largely unclear and unsubstantiated. Some proffered theories include the presence of formulation adjuvants, the use of particulate material (as with MPA), or an unknown mechanism yet to be determined.…”

“…1 It was thought that this route would be advantageous owing to the direct action of the drug on the inflamed nervous tissue, presumably ameliorating inflammation and edema, thereby reducing pain and neurologic symptoms. Other benefits of intrathecal steroids were thought to be the lower therapeutic dose required compared with systemic administration, resulting in a reduction in adverse effects.…”