Steroid Question

For the physicians on this thread, I would appreciate any information you might have on the matter of truly preservative-free depot-medrol or kenalog.

I remember well the 2000 paper in the New England Journal of Medicine which specified preservative-free depot-medrol (methylprednisolone) for intrathecal injection for postherpetic neuralgia; said specified preservative-free steroid in order to avoid arachnoiditis.

I would also mention that a mistake I see all the time is misdiagnosing lumbar pain and radiculopathy as coming from the spine/vertebrae/foraminal stenosis/disk ruptures, etc., when in fact the pain and the radiculopathy is coming from the Iliolumbar ligaments, in particular those that insert onto L4 and L5 and originate from the posterior, superior, anterior-surface, Iliac crests. Since, by very carefully placing small amounts of lidocaine at the origins on the Iliac crests, far, far away from the spine, I have often been able to identify damage to the origins of the ligaments as the true cause of particular patients' pain, it appears to me that there is a significant percentage of patients that are being needlessly placed at risk from epidural injections near the spine when that is not where the problem actually is. Just food for thought. Referred pain, as well as radiculopathy, can be very misleading; the brain does not map these areas well at all, and there appears to me to be significant variation in mapping from individual to individual, to a more frequent extent, even, than variations in physical anatomy.

In the meantime, I continue to be puzzled, as was the student nurse, over the relative merits of depot-medrol versus kenalog. I must say, however, that depot-medrol, with preservatives, does seem to present the higher risk, if used intrathecally or epidurally, but if depot-medrol is being used distally to the spine, such as, for example, into shoulder structures, I have found experientially that depot-medrol is more effective.

Best Regards To All

With regards to joint injections (knee, shoulder, hips and hands), which is better to give to the patient, kenalog + lidocaine or depo-medrol + lidocaine? Which one lasts longer and works faster?