Alcohol sclerosing injections in the UK

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Good Afternoon All.

I've been having a look for a while (mainly at US literature) at the use of alcohol sclerosing therapy for neuroma. Whilst I know we have touched upon this here on the forum nothing definitive has ever been said.

Does anybody know how I would acquire the alcohol, as I understand it, it needs mixing. Or could get it pre-mixed to use for research.

The other question, can I actually legally use it. Is it classed as a medical device?

Any help, suggestions or just a little knowledge would be of use.

Thanks,

George

 

Hi,
i have just completed a course in corticosteroid therapy injections and we touched on the subject as we read an RCT on Alcohol injections for mortons neuroma. Unfortunately the evidence is quite poor. I will try to get the name of the research paper for you to read.

 

Some reading -

This paper reports a 73 % improvement and these patients had no response in steroid injections a least 1 year before trial seems quite positive.

http://www.ahni.com/assets/files/Recalcitrant%20Intermetatarsal.pdf

 

I think the evidence is as good as for steroid injections.

Dockery (1999) examined the efficacy of 4% alcohol delivered blind, using a prospective, same subject, observational, qualitative design. 100 subjects with unilateral single lesions underwent a series of 3-7 injections at 5-10 day intervals, and re-evaluated at a mean of 13 months post-treatment. He showed that 83% of subjects reported 100% symptom improvement, and only 11% were considered failures, necessitating surgery. Dockery found a minimum of 3 injections gave therapeutic benefit, and that additional success wasn’t achieved beyond a 7th injection, based on his prior, unpublished work. He also considered a double-blind RCT would be beneficial using saline as a placebo.

Masala et al (2001) evaluated 23 subjects injected with 30% alcohol in 3-7 episodes under ultrasound guidance. They showed a short-term complete resolution of symptoms in 91% of subjects. Fanucci et al (2004) advanced this work by injecting 40 consecutive subjects, again under ultrasound guidance. Each subject underwent 4 injections at 15 day intervals, and followed up at mean 10 months post-treatment. At short-term, 90% of subjects were improved, falling to 75% at 10 months.

A small pilot study was undertaken on 8 subjects in whom conservative measures had failed. Hyer et al (2005) blind injected 4% alcohol at weekly intervals (3-9 procedures) until symptoms free or had reached the maximum 9 procedures. Subjects were surveyed 10 months post-1st injection. 2 subjects were lost to follow up, and 16.6 needed surgery. Results showed a mean VAS improvement of 75%. Mozena and Clifford (2007) examined 49 lesions with previously failed corticosteroid injection therapy. Subjects underwent 3-7 (mean 5) blind 4% alcohol injections at 3 weekly intervals, with mean follow up at 11 months.61% showed symptom resolution/improvement, and 39% no change. 24.4% needed surgery, in comparison to Masala et als (2001) and Fanucci et als (2004) 8% and 10% respectively, the latter authors using a guided approach.


Hughes et al (2007) in a larger study, prospectively examined 101 subjects after 4 fortnightly 20% alcohol injections delivered under ultrasound guidance. At mean follow up of 10 months, they showed 84% of subjects were pain-free without activity restriction. 16.85 of subjects endured symptoms due to procedural and pharmacological reasons for up to 3 weeks, and one subject experienced Chronic Regional Pain Syndrome.
3% of subjects needed surgery, and were problematic possibly as a consequence of the injectate (fibrosis of neurovascular bundle).