epidural and multiple sclerosis

[Pain Applicant1]

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What do you think about epidural steroid injections for patients with multiple sclerosis. Have you ever used it for this purpose before. I had a tough time finding any articles addressing this issue.

Helpful?
Harmful?
No difference than control?

 

[lobelsteve]

What do you think about epidural steroid injections for patients with multiple sclerosis. Have you ever used it for this purpose before. I had a tough time finding any articles addressing this issue.

Helpful?
Harmful?
No difference than control?

1. ESI does not treat MS.
2. ESI may be useful for radicular pain from HNP unrelated to MS.
3. ESI is useless for demyelinating neuropathy due to MS.

 

[Aether2000]

I agree....the pathology is intraspinal and cerebral, not epidural. I have given ESI for HNP or spinal stenosis with radicular pain in patients with MS with some success.

 

[PinchandBurn]

I agree....the pathology is intraspinal and cerebral, not epidural. I have given ESI for HNP or spinal stenosis with radicular pain in patients with MS with some success.

From my anesthesia training days, as I recall doing an Epidural on a MS patient is safe, whether it is for lumbar radic,etc.

However, doing a INTRATHECAL injection/spinal is unsafe..if I recall it can exacerbate the MS.

However, in fellowship, we had a ton of patients who had spasticity from MS and had intrathecal ITP of baclofen.

So I'm assuming the problem is with giving Local Anesthestics intraspinally to MS patients. Not just the act of doing an intrathecal injection...

 

[Pain Applicant1]

I apologize, I didn't clearly state my initial post. I meant an epidural for an MS patient with pain from DDD, etc. I didn't mean to treat the actual disease process but treating the patient for pain symptoms, keeping in mind this statement from an article from the late 80s.

"It has also been recognized since the 1960s that the epidural space is not wholly separate from the subdural and/or subarachnoid space. Many thousands of arachnoid villi subtend all the membranes from the intrathecal space, and many of these end in the large epidural veins. Therefore, the various spaces and membranes are not only contiguous, but continuous. It follows that an injection of methylprednisolone acetate into the epidural space does not guarantee that it will remain isolated there."

 

[SSdoc33]

dont overthink it, you are fine.

oarl/IV steroids TREAT MS exacerbations, so a little in the epidural space wont cause any problems

 

[Pain Applicant1]

Very good, thanks!