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This thesis was
added Chapter One Appendix One . . .
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The Presenting Symptoms Associated With Arachnoiditis And The Experience Of Living With Them In Everyday Life A thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University by Christine Hopkins - 1998 Appendix Two.Depo Medrol - methylprednisolone acetate USP Depo Medrol is an anti-inflammatory steroid that exerts its influence locally by preventing or suppressing the development of inflammation. It is used intra-articularly and intramuscularly as an adjunctive treatment for pain relief in osteoarthritis, rheumatoid and other arthritic conditions, bursitis, tenosynovitis and epicondylitis. Such local therapy does not alter the underlying disease process. Spinal joints are not recommended as sites for administration because of their inaccessibility and the sacroiliac joint because it lacks a synovial space. The Upjohn Data Sheet (1988) specified that Depo Medrol is not recommended for intrathecal or epidural administration. Adverse effects possible when these routes are used are noted as including arachnoiditis, meningitis, paraparesis/paraplegia, sensory disturbances, bowel/bladder dysfunction, headaches and seizures. Side effects of its usage include muscle weakness, menstrual irregularities, osteoporosis, vertebral compression fractures and pathological fractures of long bones. In 1990 a television programme on Depo Medrol was aired in Australia, which the medical director of Upjohn referred to as “an Australian tabloid television programme, which has been described as sensational, biased and unbalanced.” The director also noted that the “advent of contentious television is regrettable.” As a result, correspondence between UpJohn and the New Zealand Pain Society (1990) ensued. Upjohn noted, and asked the Society to share with its members, that it does not, and cannot recommend, epidural or intrathecal use of Depo Medrol because sufficient scientific data regarding the safety and efficacy of this use does not exist. In the same letter, Upjohn notes that the decision to use a specific treatment in a specific situation remains the prerogative of the doctor, in agreement with, and after discussion with, the patient. The letter also pointed out the impossibility of ever conducting an unbiased clinical trial because, by the time all the potential problems were listed for informed consent, only truly committed people would volunteer for such a study. Obtaining a random and objective sample of either doctors or subjects would not be possible. Since 1991, Upjohn has changed the data sheet to include an underlined warning that epidural use is not a recognised usage of Depo Medrol. Subsequently, it has been recommended that patient information sheets should be given to people prior to epidural injection of Depo Medrol. References Upjohn Data Sheet, 1988. Correspondence from Upjohn to the New Zealand Pain Society, 1990. Kenacort-A40 (Triamcinolone acetonide) Kenacort is recommended for the same inflammatory joint conditions as Depo-Medrol. The data sheet notes that it will ameliorate symptoms but has no effect on the causes of the inflammation. Intramuscular and intra-articular administration are the recommended routes. No mention is made of intrathecal or epidural administration, or of arachnoiditis as a possible side effect. Reference Bristol-Myers Squibb Fact Sheet, 1991 |
