Triamcinolone Acetonide needs to be injected directly into the affected muscle if it's being used to treat muscle pain. Injecting it into the gluteus maximus will not provide a differential diagnosis if that is not the affected muscle.
Simply not true, while corticos have some localized effect, if one is uncertain about the location of the inflamation or if one has multiple injuries in different locations it can be more effective to inject it into a large muscle such as glutes or quads that will allow for quick distribution to the entire body...and even if the problem is nerve compression it can still help for that. If the pain is in the lower back your best bet would be the upper glute on the side that the pain seems the worse rather than trying to guess if it's the multifidus or the iliocostalis lumborum or an interspinales muscle and trying to inject directly into it.
However, following your logic...where exactly would you recommend it be injected for the treatment of chronic sarcoidosis?
There are oodles of alternatives if it is a herniated disk or nerve inflammation. Good physiotherapy, ultrasonic therapy, transcutaneous electrical nerve stimulation are needed. The first line medications for neuropathic pain are tricyclic antidepressants, selective serotonin-norepinephrine reuptake inhibitors (SSNRI's), and anti-convulsants like Gabapentin.
I agree with the physical therapy recommendation, the others are no more going to treat underlying causes than opiates and, on the average, tend to be less effective.
Next are you going to recommend acupuncture? LOL.
Opiods may be used as adjunctive therapy, but the rapid tolerance to them, and associated problems rule them out as first line drugs.
Wow...sounds like you're quoting an FDA website. However, dispite this paranoia in regard to opiates in some
segments of the medical community, most doctors I know would at least prescribe hydrocodone as the first line of drugs.
At any rate, a multidisciplinary team approach is what's needed to provide a combination of physical and pharmocological therapies- which is what a Pain Clinic is for.
A pain clinic is for those people who are taking 160mg of oxycodone a day and still unable to manage their pain.
Don't get me wrong, I understand where you're comming from, you unfortunately have many allies, especially at the bureaucratic levels of medicine (and fortunately fewer amongst the younger generation of doctors)...but it represents a paranoid fear of chemistry and pharmacology that prevents me and many others from trusting a doctor without experience about his medical practices and philosophy.