Depo-Medrol: Another Good Reason to Choose Prolotherapy
Robert Filice, M.D.

Depo Medrol is the synthetic steroid (cortisone) medication used when physicians administer an epidural for the relief of severe low back pain and nerve impingement symptoms. It is possible that some patients will experience a certain amount of pain relief for a brief period of time, but it is strictly temporary, and it is a palliative procedure only. Even the doctors that use this procedure are divided over the safety and efficacy of depo-medrol. It certainly does not get to the root of the problem, which in most cases is ligament damage or weakness. What is little known about the “epidural” is that the depo-medrol commonly used contains two potentially toxic preservatives that are being placed directly into the sack around the spinal cord: polyethylene glycol and benzyl alcohol. Most medications administered intrathecally or intraspinally are compounded and are preservative free. Yet a preservative containing drug is used for epidurals. What difference does this make?

There have been many cases of arachnoiditis linked to epidural procedures using depo medrol. Arachnoiditis describes a pain disorder caused by the inflammation of the arachnoid, one of the membranes that surround and protect the nerves of the spinal cord. The arachnoid can become inflamed because of an irritation from chemicals, infection from bacteria or viruses, as the result of direct injury to the spine, chronic compression of spinal nerves, or complications from spinal surgery or other invasive spinal procedures. Inflammation can sometimes lead to the formation of scar tissue and adhesions, which cause the spinal nerves to "stick" together. If arachnoiditis begins to interfere with the function of one or more of these nerves, it can cause a number of symptoms, including numbness, tingling, and a characteristic stinging and burning pain in the lower back or legs. Arachnoiditis has no consistent pattern of symptoms, but it more frequently affects the nerves that supply the lower back and legs. Arachnoiditis is a difficult condition to treat, and long-term outcomes are unpredictable. Most treatments for arachnoiditis are focused on pain relief and the improvement of symptoms that impair daily function. A regimen of pain management, physiotherapy, exercise, and psychotherapy is often recommended. Surgical intervention is controversial since the outcomes are generally poor and provide only short-term relief. Arachnoiditis appears to be a chronic pain disorder that is not progressive, but does not improve significantly with treatment.  For many, arachnoiditis is a disabling disease that causes chronic pain and neurological deficits. 

As you can see arachnoiditis is a serious possible complication of epidural pain management procedures. There is much litigation currently going on involving patients who were not fully informed of the risks of their epidural procedure with depo–medrol. As a result my advice to our readers is to avoid epidural procedures if at all possible. If it is absolutely mandatory that you have this procedure for control of pain, speak to your doctor and insist that he use a medication without preservatives. Most importantly, be aware that Prolotherapy for chronic and severe back pain does not carry a risk of arachnoiditis, and is often effective quickly enough to obviate the need for epidurals.