Transdermal patches can be a very precise time released method of delivering a drug. Cutting a patch in half might affect the dose delivered. The release of the active component from a transdermal delivery system (patch) may be controlled by diffusion through the adhesive which covers the whole patch, by diffusion through a membrane which may only have adhesive on the patch rim or drug release may be controlled by release from a polymer matrix. Cutting a patch might cause rapid dehydration of the base of the medicine and affect the rate of diffusion.
Most patients with back pain will not benefit from surgery. However, if anatomic abnormalities consistent with the distribution of pain are identified, surgery can be considered in persons who have experienced significant functional disabilities and in those with unremitting pain, especially pain lasting longer than 12 months despite multiple nonsurgical treatments. Good evidence supports the use of spinal fusion for treating back pain caused by fractures, infections, progressive deformity, or instability with spondylolisthesis. 7 Spinal decompression, nerve root decompression, and spinal fusion have been extensively evaluated for the treatment of degenerative disorders of the spine, mostly with short-term outcomes, yielding conflicting results and questionable patient benefit. 39 Disk arthroplasty (replacing the original intervertebral disk with an artificial one) appears to be as effective as lumbar fusion for short-term relief of chronic low back pain, but there is no evidence of long-term relief, and concerns exist regarding the durability of the artificial disks. Intradiscal electrothermal therapy is a technique that applies heat to a damaged disk through a catheter, causing collagen contraction for structural support and ablating nearby pain-sensing nerves for pain reduction. It has been shown to provide modest pain relief, but little functional improvement. 40
Kenalog in blood - Derby et al. "Size and aggregation of corticosteroids used for epidural injections"