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In reviewing data from four previously published studies of treatment with lidocaine alone or with the steroid resulted in evidence that cervical epidural injections with lidocaine alone or in combination with the steroid betamethasone alleviated pain and improved functionality in patients with neck pain. In fact the outcomes were very similar calling into question the need for the steroid

In light of these concerns, in November 2004, the US Food and Drug Administration (FDA) placed a black box warning on Depo with two highlights: Prolonged use may be associated with considerable loss of bone mass especially in adolescent girls, Bone losses may not be completely reversible after stopping Depo Provera

Some clinicians prefer to use a methylmalonic acid (MMA) test in place of a homocysteine test, but MMA is also a non-specific biomarker

Vascular: Ultrasound (Doppler) to evaluate blood flow

But some might take longer, so its key to watch closely