To the Editor.
—The warnings of methylprednisolone use in epidural analgesia by Dr Nelson1 raises important issues for physicians caring for patients with chronic low-back pain. As he noted, there is no doubt that polyethylene glycol is neurotoxic, and is the likely cause for sterile meningitis when methylprednisolone is injected in the subarachnoid space. It is noteworthy that corticosteroids have not been approved for intrathecal use by the Food and Drug Administration. The package insert for methylprednisolone acetate (Depomedrol, Upjohn) states "not recommended" for subarachnoid injection.A large body of clinical experience suggests the use of local anesthetics and steroids in the epidural space is a safe and effective treatment for the conservative management of low back pain in which there is reasonable evidence that inflammation of nerve roots is the cause of the symptoms. Two steroids, methylprednisolone acetate, 40 to 80 mg (Depomedrol, Upjohn), and triamcinolone diacetate
Haynes G, Bailey MK, Davis S, Mahaffey JE. Use of Methylprednisolone in Epidural Analgesia. Arch Neurol. 1989;46(11):1167–1168. doi:10.1001/archneur.1989.00520470017014