Hi sublime, I was wondering if Carol cut this from one of the many recent article about the use of steroids in the epidural space. Aside from what she said, It's not FDA approved either.
"Not only can they cause tissue destruction, but they can cause arachnoiditis, a horribly painful disease....there have been, according to what I read, 350 deaths in the last 4 years and l5,000 medical "events". Pretty high stats as far as I am concerned. The steroids used are NOT approved by the FDA for the purpose of epidural injections and a warning to that effect is being placed in the literature. My guess is that a lot of doctors don't even know this. PM clinics have to just hate this news leaking out....after all, that's how they make their big $$$$ and its why many of them say they won't do PM with meds only."
There is also the risk of nicking the Dura and causing a spinal fluid leak. I have had 4 blood patches in the last 9 years and 3 were from ESI's where the needle had to be pushed so hard through scare tissue they didn't stop in time to prevent going directly into the thecal sac and spinal cord. The spinal headache is the most intense headache you can imagine because you brain sets down on your skull when you loose spinal fluid.
Blood patches are used to correct the problem but some docs make folks ride it out hoping the puncture or nick will close on it's own, Eventually scar tissue will close it but spinal fluid has no clotting ability on it's own.
However I have read folks that did get relief from ESI. Every clinical trial done shows the existence of the placebo effect. If the doc does a great job on selling the idea and the patient has great belief it will work, you have to wonder if the % of people that it works on is any higher than those that saline would work on.
Being cured by an EMG is pretty unheard of. It's simply a diagnostic test to measure the speed and interference of a tiny amount of electric current run from point A to point B. I'm glad your SIL is feeling better, But I have had several and they have no curative property I know of. I have also done TINS, where they attach electrodes to acupuncture needles and zap you. It gives deeper stimulation than a TENS unit. Didn't do squat either, I do go into each modality with the hopes this is it, You would think I would be more cynical but when you see what's possible on those trauma and Super surgeries shows it's amazing.
I watched one where they replaced 2 destroyed vertebrae from a tumor and radiation with a titanium spacing device.They actually removed 2 lumbar vertabrea and with the spacer the guy could walk again. They also filled a hollow tube portion with crushed bone hoping to add some fusion stability although the hardware was designed to take the brunt for years/indefinitely.
The reason FDA has not approved steroids use in the epidural space is because no study has been done to reviel whether the actual benefit is any higher than the test group that receives saline or another benign substitute.
It's just another example of off label use of medication. It's done procedurally all the time. There isn't a Pedicle screw that has FDA approval and yet they have been using these huge hex head lag bolts designed and approved for the Femur in the spine for decades. They have only taken on the term pedicle screw because this is where they place the screws in the spine, "the pedicle".
It doesn't mean this screw was designed for the spine. In fact , there isn't a lick of titanium or stainless steal hardware that has FDA approval aside from Harrington rods used to correct or limit scoliosis, and Harrington rods got their approval with the technique of anchoring the rod to vertebrae with wire and hooks. Not pedicle screws.
So non approved use occurs all the time, they basically have you sign your rights away with informed consent forms and waivers.
I would probably do one and see if it helped. If it just made you hurt more until it dispersed, I would seriously consider canceling the next 2. They can only do 3 a year, Nut I have been at this long I know I have had at least a half dozen. You'll try anything to relieve pain, especially when docs are stingy with pain meds while trying to figure out what to do.
What ever you decide, Good luck, Dave
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