I have a patient whom recently moved to my area from NYC with a history of MS and fact mediated pain. Has always been nervous about spinal procedures as his neurologist at major academic center back in NYC told him to never get an epidural injection. I have done lumbar MBB x2 with >60% relief each time. He talked to his new local neurologist about RFA and now doesn't want to proceed as neurologist gave vague uncertain answer about safety of RFA with a history of MS. Pretty much everything that I have read say that there are no issues with RFA in MS patients, but is there something out there that I am unaware of, or is this neurologist just being intentionally vague because they just don't know the answer?
RFA on MS patient
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this:
neurologist just being intentionally vague because they just don't know the answer?
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No additional risk.
No mechanism of additional risk.
No rationale for neurology comments. But if you talk to a few neurologists.....
Except my sister. She is the smart one.
No mechanism of additional risk.
No rationale for neurology comments. But if you talk to a few neurologists.....
Except my sister. She is the smart one.
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Had a ms pt come to me on 50mcg fentanyl and a general mess. Post RF, she is off opioids and again a functional human. Just saw her back after a repeat RF 1.5 yrs after first, doing great.
I've done several on ms pts, maybe a bit more spasm in weeks after, but haven't noticed any other difference.
I've done several on ms pts, maybe a bit more spasm in weeks after, but haven't noticed any other difference.
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From my anesthesia board studying days, we were cautious to use intrathecal anesthesic, judicious with non depolarizers, and avoid depolarizers, in patients with MS.
Peripheral nerve blocks, rfa, joint injections, I can't identify any issues.
Peripheral nerve blocks, rfa, joint injections, I can't identify any issues.
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Just to clarify...You guys do not do ESI on MS patients? I have one who needs a CESI...I am somewhat leery...
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MMS is not a contraindication to any procedure we do.
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Why not?
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I have not ever been taught that you should absolutely not do ESI on MS patient. However OP mentioned it above. I suppose the concern would be in the neck especially that if they have a neurologic deficit soon after your procedure...was it your injection or the MS? Also, I thought I heard that it could trigger a flare in some...
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if you do an ESI on an MS patient, just do a super thorough neuro exam preprocedure, and make sure patient is aware that any flare up is not due to the epidural.
people may come in with new symptoms - but prep them that those are due to their underlying MS and not the injection (unless of course you transected the cord or caused an epidural abscess)
people may come in with new symptoms - but prep them that those are due to their underlying MS and not the injection (unless of course you transected the cord or caused an epidural abscess)
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Facet RFA is no different in MS than patients without MS. Agree with above, that the neurologist may not have known how to answer detailed questions about RFA and that the patient is feeding off of that. I don't try to push procedure-leery people into interventions. I just explain the procedure, the pro's /con's, what it may do/not do, and if they're unsure, I tell them to call me when they've made a decision on what to do. Choosing to live with the pain is always an option, if the patient chooses to do so.
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I'm not sure how a steroid injection would trigger an MS flare, when it's high dose IV steroids that the neurologists reach for first-line to stop MS exacerbations.
This sounds like a bunch of "some other doctor said" gobblediegook a patient is pulling out as reason to reject a procedure out of hand, without having to actually weigh the pro's and con's. Sometimes they're skeptical or needle phobic. Okay, fine. Other times the "My doctor said never to have that procedure or I'd die" stuff is just foreplay for, "...And he said the only thing that would work is 'pain management,' you know, roxicodone, and he said it's illegal for him to give it to me. But you could!"
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Steroids do not trigger MS. Without an epidural abscess, hematoma or puncture hole in the spinal cord from your needle, there's no reason to think an MS exacerbation, that by coincidence happen after your injection, was related to the injection. MS damages brain and cord white matter by causing plaques on MRI. Those look nothing like cord stab wounds, epidural abscesses or hematomas. Again, your steroids injected are not going to make MS flare. If anything, it makes it less likely. Steroids stop MS flares, they don't cause them. And injection complications that damage nerves and cord look nothing like MS flares, on MRI.
MS flare: Neurologist gives IV methylprednisolone to stop it.
Your CESI: Methylprednisolone (long acting, DepoMedrol version; or some other corticosteroid equivalent).
