alternative medications to steroids for epidural injections

[promethius]

For patients who cannot or do not want to have steroids for an epidural injection, are there alternative medications one could use that would be almost if not equally as effective? I heard of people using Traumeel, Zeel, and Sarapin for trigger point injections. Are there any contraindications for using Traumeel, Zeel, or Sarapin for epidural injections? Thanks!

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[lobelsteve]

Saline alone has been used as a comparator in studies. Using any of the agents you mentioned places an enormous burden on the injecting doc if a complication occurs.
Not recommended.

 

[Aether2000]

The practice I am in now has used TZ epidural injections for many years for those adverse to steroids. I have been very surprised they actually result in significant and sustained pain relief for some patients. So far no side effects. I agree with the legal risks.

 

[Timeoutofmind]

For patients who cannot or do not want to have steroids for an epidural injection, are there alternative medications one could use that would be almost if not equally as effective? I heard of people using Traumeel, Zeel, and Sarapin for trigger point injections. Are there any contraindications for using Traumeel, Zeel, or Sarapin for epidural injections? Thanks!

Did one yesterday with local and saline for a gal with pretty significant epidural lipomatosis

Do u guys inject steroid in these pts?

 

[lobelsteve]

Nope. Nothing works but weight loss, failing that, decompression.

 

[Gauss]

there are published case series using autologous conditioned serum (orthokine) and alpha 2 macroglobulin (Apic-SF) for radiculopathy. Assuming the preparation is sterile, these are autologous blood products with a presumed lower risk than Traumeel. Does the FDA have any authority over traumeel and its manufacturing process?

 

[Aether2000]

Of course don't forget about etanercept.... http://www.medscape.com/viewarticle/813862

Or epidural ozone... http://www.indianjpain.org/article....lume=29;issue=2;spage=64;epage=72;aulast=Joel

 

[Ligament]

Traumeel is a homeopathic remedy, so how does it work?

 

[Aether2000]

Probably no different than how saline works since it is homeopathic....

 

[lobelsteve]

Probably no different than how saline works since it is homeopathic....

How dilute do you make water to give it healing power?

 

[Aether2000]

Good question! Most homeopathic remedies are so insanely dilute there is not one molecule of the substance on the label in the vial. However, there are some homeopathic solutions that are not really homeopathic at all...and are at the 1-2% level of concentration. I personally believe Zeel/Traumel work through dilution of inflammatory substances via effectively 100% saline. They come in sealed glass ampules. Surprisingly, there are many patients from this particular practice that actually ask for the stuff as an alternative to steroids.

 

[Stim4me]

Steroids: saline: hyaluronidase
Or go pulsed drg.

 

[Aether2000]

How about using hyaluronidase along with ozone (to help the ozone spread). Could throw in some hypertonic saline too......

 

[NOSfan]

Have utilized Clonidine with success in those with true steroid allergy or brittle diabetics.

 

[Stim4me]

Have utilized Clonidine with success in those with true steroid allergy or brittle diabetics.

Nice post. Would suggest dexamatomidine would be an even more alpha specific option down the road...

 

[bedrock]

Have utilized Clonidine with success in those with true steroid allergy or brittle diabetics.

Interesting idea.

I have found that many diabetics and old people who do poorly with Dex, will tolerate 20-40mg of depomedrol.

 

[Gauss]

Probably no different than how saline works since it is homeopathic....

Is saline really homeopathic?
saline is superior to placebo (sham) http://www.bmj.com/content/343/bmj.d5278
it's effect in knee OA is also better than placebo http://journals.sagepub.com/doi/full/10.1177/0363546516680607

 

[jsaul]

for those that use ozone, which generator do you use? Do inject into the disc?

I have a patient who stated she got ozone injected into her L4-5 4 years ago and worked well. Now she has L5-s1 disc protrusion and wants intradiscal ozone