The Stanly News and Press (Albemarle, NC)

December 12, 2012

What is known about epidural steroid injections?

By Dr. Larry Bridge for the SNAP
SNAP

Wednesday, December 12, 2012 — In the United States, epidural steroid injection is used extensively for the treatment of back pain even though current literature on these drugs states that it is contraindicated for intrathecal (around the spinal cord and nerves) administration. It contains presevatives such as polyethylene glycol (antifreeze) and alcohol that can be toxic to nerve tissue.  

Since September 2012, there has been an increase in reports on negative side-effects associated with epidural cortico-steroids injected into and around the spine that came from one manufacturer of these drugs. The Centers for Disease Control has put the total multi-state cases (in the last 3 months) count at 541, revealing 363 cases of meningitis, 153 cases of paraspinal/spinal infection, 17 cases of peripheral joint infection, eight strokes and 36 deaths.

Controversy has always surrounded the use of epidural steroid injections (ESI) for lower back pain. Recent studies show that they have become one of the most popular ways medical physicians treat neck and back pain, with nearly 9 million  administered last year, even though they have not been approved by the Food and Drug Administration for this use. In the past 10 years the number of ESI’s has increased more than 150 percent just for Medicare patients alone with more than $106 million paid out for this procedure last year.  Total ESI costs in the U.S. are nearly $20 billion a year and pain management, estimated at more than $300 billion per year, is one of the fastest growing areas of medicine today.

How They Work

Simply put, epidural steroid injections contain corticosteroids and when given in doses that exceed the natural levels found in the body they can reduce inflammation around irritated nerves. It can help reduce pain temporarily, usually for less than six months. Injections are usually limited to three or four per year due to a risk of side effects including bone and muscle weakness, nerve damage, elevated blood sugar levels, fluid retention, weight gain, osteoporosis, suppression of normal hormone balance and with more serious side effects occurring in less than 5 percent of patients. In one study of 40 patients with low back pain, sciatica symptoms, spinal stenosis or lumbar disc herniation, each were given from one to five injections over eight months. Overall results showed 60 percent reported some degree of relief from leg and back pain immediately after injection, but at follow-up examination only 24 percent were better, 40 percent were the same and 35 percent had varying degrees of relief with no consistent pattern. The overall results of this study showed that 50 percent may have some short term relief, but no long term benefits. Three medical professional organizations concluded that ESI treatment had no impact on improving functional impairment, decreased the need for surgical intervention or provided long term pain relief.  

Conclusion

People who suffer with back pain, sciatica, facet syndromes or spinal stenosis should always try conservative treatment options for relief, before opting for more invasive treatments like epidural steroid injections or spinal surgery. Options include chiropractic care, spinal decompression traction, medication, exercise, physical therapy and acupuncture. In a recent Consumer Reports survey, ciropractic was rated by readers as the most effective treatment for lower back pain. See a chiropractor today and get on the road to wellness and pain relief.