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Therapeutic effect of epidural dexamethasone palmitate in a rat model of lumbar spinal stenosis
  1. Mei Hui ­LI1,2,
  2. Haiyan Zheng3,
  3. Eun Joo Choi2,4,
  4. Francis Sahngun Nahm2,4,
  5. Ghee Young Choe5,6 and
  6. Pyung Bok Lee2,4
  1. 1Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Jongno-gu, Korea (the Republic of)
  2. 2Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  3. 3Department of Anesthesiology, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China
  4. 4Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea (the Republic of)
  5. 5Pathology, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  6. 6Pathology, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea (the Republic of)
  1. Correspondence to Professor Pyung Bok Lee, Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of); painfree{at}snu.ac.kr

Abstract

Background Dexamethasone palmitate (DEP), a prodrug of dexamethasone (DEX), is a synthetic corticosteroid medication distinguished by the inclusion of a fatty acid component known as palmitate. This study introduces DEP as a novel therapeutic option for spinal epidural injection, aiming to provide safer and longer-lasting pain relief as an alternative to for patients with spinal stenosis.

Methods 40 rats were randomly divided into four groups: those receiving epidural administration of normal saline (NS), and DEP in the lumbar spinal stenosis (LSS) model, and non-model rats receiving epidural NS administration. Paw withdrawal thresholds to mechanical stimulation and motor function (neurogenic intermittent claudication) were observed for up to 21 days. Hematology and blood chemistry analyses were performed 1 week after drug therapy. Tissue samples were collected for steroid pathology examination to evaluate adhesion degree, perineural area inflammation, and chromatolysis in the dorsal root ganglion (DRG), and adrenal gland.

Results The DEX and DEP groups demonstrated significant recovery from mechanical allodynia and motor dysfunction after 2 weeks of drug therapy (p<0.001). However, by the third week, the effect of DEX started to diminish while the effect of DEP persisted. Furthermore, the DEP group exhibited reduced fibrosis and less chromatolysis than the NS group. No steroid overdose or toxin was observed in any group.

Conclusion The epidural administration of DEP demonstrated therapeutic efficacy in reducing allodynia and hyperalgesia resulting from chronic DRG compression, thus offering prolonged pain relief. These findings underscore the potential of DEP as a promising treatment alternative for pain associated with LSS, serving as a viable substitute for .

  • Injections, Spinal
  • Back Pain
  • Pain Management
  • Drug-Related Side Effects and Adverse Reactions

Data availability statement

Data sharing not applicable as no datasets generated and/or analyzed for this study. No data are available.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analyzed for this study. No data are available.

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Footnotes

  • Contributors MHL: conducted experiments and contributed to manuscript writing. HYZ: contributed to manuscript preparation. EJC: contributed to manuscript preparation. FSN: validated the data. GYC: conducted investigation. PBL: supervised the study and acted as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.