Question about epidurals...

[DougFlutie]

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Does anyone have a website where I can read up about steroidal epidural injections? Specifically, the mechanism that reduces inflammation and the reason that they lose their effectiveness after the 3rd or 4th procedure.

Thanks.

 

[uptoolate]

I don't know the answer to your question....but I wanted to confirm my presumption that you're a BC grad?

 

[DougFlutie]

I don't know the answer to your question....but I wanted to confirm my presumption that you're a BC grad?

Actually, no. Just a big Flutie fan who is quietly willing Tom Brady to die so that Flutie can take his rightful place at the helm of a championship team.

 

[Skialta]

This is more of a pharm question? Prednisone/glucocorticoids have complex actions that reduce inflammation/modulate immune reaction. Pick up a good pharmacology text. It is really the same whether it is being injected into soft tissue or nerve.

 

[DougFlutie]

This is more of a pharm question? Prednisone/glucocorticoids have complex actions that reduce inflammation/modulate immune reaction. Pick up a good pharmacology text. It is really the same whether it is being injected into soft tissue or nerve.

I guess to be more specific, I'm wondering what it is that causes epidurals to decrease in effectiveness over a series of continuous administrations.

 

[Skialta]

If you are refering to chronic lbp and the use of epidurals/nerve root injections, then the mechanism of the pain is the question and not so much the mechanism of the drug. Think about something like RA, people can be consistantly on corticosteroids for extremely long periods of time, works well against the inflammation, but sequele of steroid is hard on the body, but they do their job and decrease inflammation. The case of epidural for LBP is a little more cloudy, usually you are dealing with nerve root inflammation from stenosis of the intervertebral foramen, in that case you are talking about a progressive process in which there is continued narrowing over time resulting in increased compression of the nerve root. Initially steroids may help reduce the nerve root irritation/swelling in early stages of the disease, but eventually they may not alleviate the symptoms. The response of steroids to this kind of process is pretty variable, some patients only need one injection and may be "cured of pain", while others may not have any relief at all, or only minimal relief, and then there are those inbetween who get injections every 4 months or so on a continuing basis. Hope that helps

 

[DougFlutie]

If you are refering to chronic lbp and the use of epidurals/nerve root injections, then the mechanism of the pain is the question and not so much the mechanism of the drug. Think about something like RA, people can be consistantly on corticosteroids for extremely long periods of time, works well against the inflammation, but sequele of steroid is hard on the body, but they do their job and decrease inflammation. The case of epidural for LBP is a little more cloudy, usually you are dealing with nerve root inflammation from stenosis of the intervertebral foramen, in that case you are talking about a progressive process in which there is continued narrowing over time resulting in increased compression of the nerve root. Initially steroids may help reduce the nerve root irritation/swelling in early stages of the disease, but eventually they may not alleviate the symptoms. The response of steroids to this kind of process is pretty variable, some patients only need one injection and may be "cured of pain", while others may not have any relief at all, or only minimal relief, and then there are those inbetween who get injections every 4 months or so on a continuing basis. Hope that helps

It does, thank you. From your response I take that each individual responds differently, and while steroids may reduce inflammation caused by stenosis, it may not do anything for the actual "pain" for those in later-stages of stenosis (to the point of neurogenic claudication). I've been looking, but I've yet to see any information about the dosing of analgesics in epidural shots in conjunction with steroid use. Any thoughts on that?