To the Editor.
—In response to my July 1988 review article in the Archives1 concerning intraspinal steroid therapy, a recent letter by Haynes et al2 was published, which further extends the controversy that began in 1970.3 Haynes et al2 stated that epidural instillation of certain steroid compounds was a safe and effective treatment for chronic low back pain syndromes in which the pathologic findings were due to inflammation of nerve roots; however, intrathecal therapy was described as risky. In my experience, the concept of treating "inflammation" is doubtful at best, due to the fact that most patients present with chronic pain due to chronic cicatrix. The core of the present conflict, however, revolves around the toxicity of polyethylene glycol contained in several steroid compounds now in use, particularly methylprednisolone acetate and triamcinolone diacetate. Beginning in 1980, after The Upjohn Company (Kalamazoo, Mich) issued a warning concerning
Nelson DA. Dangers From Intraspinal Steroid Injections. Arch Neurol. 1990;47(3):255. doi:10.1001/archneur.1990.00530030019009
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