Pfizer had received hundreds of complaints about injuries and complications related to the injections. A review of FDA records showed that 2, serious problems, including deaths, were reported from Depo-Medrol injections performed from through March of Most injuries occurred when the needle missed the epidural space and directly injured the nerves or deprived the spinal cord of blood when placed into the spinal fluid or arteries. James Patrick Murphy, an anesthesiologist and addiction specialist in Kentucky, said in the Times article that he believes the injections are an expensive procedure, especially when there is no promise of a cure.
He believes that recent studies showing that the injections work no better than physical therapy for many patients are reason enough not to use them. Indeed, FDA warned in that injections of corticosteroids into the epidural space of the spine may result in rare but serious adverse effects, including loss of vision, stroke, paralysis, and death.
The number of Medicare beneficiaries receiving these injections had increased by 7. Corticosteroids such as methylprednisolone, hydrocortisone, triamcinolone, betamethasone, and dexamethasone are FDA-approved for injection into muscles and joints. Nevertheless, they are commonly injected along with an anesthetic into the cervical and lumbar regions of the spine.
Despite the fact that this application is considered off-label use, in June the House of Representatives approved an increase in Medicare reimbursement for the procedure as part of legislation to tackle the opioid crisis.
Fudin told Practical Pain Management. Opioids and epidural corticosteroid injections should only be used after safer and more conservative options have been tried, according to Drs. Goldstein and Mauro. They recommend the following approach for use in a multi-disciplinary pain management center:. Even so, Drs. Goldstein and Mauro caution that despite producing an immediate reduction in pain, epidural injections are very technique-sensitive, and their benefits are often small.
Some pain clinics are refusing to prescribe any opioids unless patients agree to receive the spinal injections. Goldstein and Mauro consider this a ploy to have patients accept a much more expensive treatment. When it comes to low back pain LBP , for example, recent guidelines published by the American College of Physicians report that improvements in pain and function show little to no differences, compared to controls, whether patients receive pharmacological or nonpharmacological treatment.
For chronic LBP, exercise, multidisciplinary rehabilitation, acupuncture, and mindfulness-based stress reduction are considered to have the best evidence base. According to Dr. Fudin, all interventions and medications come with risks that may be offset by variable levels of analgesic benefit.
Since steroids injected into the epidural space are not an FDA-approved indication, clinicians recommending or performing such procedures must carefully outline the risks without minimizing them, especially for a vulnerable patient who may otherwise disregard such risks in the presence of unrelenting, intolerable pain. Kaplan S. The New York Times : July 31, April 23, Success rates for cervical epidural steroid injections are largely subjective, though the main factor patients consider in their success is pain relief and management.
Several studies have been conducted to quantify the efficacy of these treatments, with varying results. One study by the Journal of Spinal Disorders and Techniques in , followed 70 patients through their cervical epidural steroid procedure. Though some pain-relieving results have been noted by patients and clinics alike, there is simply not enough clinical data to support using cervical epidural steroid injections as a way to manage pain caused by pinched nerves.
Though pain relief using steroidal injections may be possible for some, most data supports that prolonged use of such treatments can cause worse issues to manifest in any patient using such treatments. As with any medicine, risks exist when applying cervical epidural steroid injections. While doctors and clinical specialists can offer some guidance, it is ultimately up to the patient to decide if these risks outweigh the benefits when choosing to apply steroids to their issue.
Fortunately, steroids have been used as a treatment for nerve pain for several decades, so there is plenty of clinical data to look towards when weighing the risks. Some of the more rare but severe side-effects of cervical epidural steroidal injections include:. Infection due to steroidal injection is fairly uncommon, though not completely absent.
In an article posted by the Center for Disease Control in , the organization discovered an outbreak of a deadly strain of meningitis that traced back to three lots of contaminated steroid solutions made in Massachusetts. A month after the article was posted, the FDA had identified cases of the outbreak with 12 confirmed deaths in 10 states due to the bad batch of steroids.
One of the most studied and generally accepted risks of repeated steroid use is weakened bone and muscle structure. Studies have indicated that bone mineral density decreases with repeated steroid use and that these treatments significantly increase the chances of a person developing osteoporosis and osteopenia. These weakened bone structures were also linked to increased risk of bone fracture according to one scientific journal. While cervical epidural steroid injections are still a fairly common treatment throughout the US, the risks included may be enough to dissuade potential patients from attempting such treatments.
Furthermore, other conservative treatment options physical therapy and over-the-counter medication may not provide enough relief from inflamed or pinched nerves to satisfy some patients. While surgery may seem like all a patient is left with, this may not be the case due to recent advancements in the field of Regenerative Medicine. While steroidal injections may relieve the pain caused by inflamed and pinched nerves, the underlying issue persists and may get worse over time due to the characteristics of steroids.
Regenerative therapies offer a solution to these problems by treating both the symptoms of inflamed nerves and their inciting factors. Furthermore, mesenchymal stem cells and Platelet Rich Plasma PRP injections such as those offered at Cellaxys, do away with many of the potential risks of steroid injections as the source materials come directly from the patients and are administered using state of the art technologies.
By harvesting and processing tissues such as blood and bone marrow, directly from the patient, they will be put back into the painful regions. Mesenchymal stem cells are obtained from the bone marrow. By applying these mixtures via live X-ray fluoroscopy guided injection, our doctors can ensure the treatments reach the locations where they will be most effective.
While steroidal injections may provide immediate relief in some patients, the potential risks may outweigh benefit a patient is hoping to experience. Several studies have confirmed the risks cervical epidural steroid injections carry and many more have shown these treatments as ineffective with prolonged use. For those seeking an alternative, perhaps Regenerative Medicine is the answer.
If you would like to learn more about how Regenerative Therapies can help treat your nerve pain, contact the Cellaxys offices today to set up a consultation. No matter your orthopedic or spine condition, our Cellaxys experts offer optimal solutions. Our team of elite physicians have collectively performed over 30, procedures and have over 20 years of experience in the Las Vegas medical community. Email: [email protected]. This site contains no medical advice.
Injections for Neck and Back Pain Relief. Cervical Epidural Steroid Injection Video. Epidural Steroid Block Video. Epidural Steroid Injections. Sciatica Treatment. You are here Treatment Injections. By Richard Staehler, MD. Peer Reviewed. Epidural Steroid Injection Video. Safety of Epidural Corticosteroid Injections. Drugs R D. Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain. Pain Physician. Treatment of acute sciatica with transforaminal epidural corticosteroids and local anesthetic: design of a randomized controlled trial.
BMC Musculoskelet Disord. Published May Cham, Switzerland: Springer; Chang, Douglas, Zlomislic, Vinko. Chapter Lumbar Spinal Injections. In: Chapman, Michael W. Chapman's Orthopaedic Surgery. Accessed June 26, Hassan KZ, Sherman Al. Epidural Steroids. In: StatPearls [Internet]. Usually, you'll be able to return to normal activities on the next day. The steroids usually begin working within 1 to 3 days. In some cases, you might need up to a week to feel the benefits.
Many people get several months of improvement of pain and function from the injections. If the injection is effective, it can be repeated. If you have any side effects, be sure to contact your healthcare provider. If you don't have pain relief, talk with your healthcare provider. This may be a sign that the pain is coming from some place other than the spinal nerves. Health Home Conditions and Diseases. Sometimes pain relief is short term. Other times the benefits continue for some time.
Why might I need an epidural steroid injection? A number of conditions may add to this narrowing, including: Herniated disks "Slipped" vertebrae Joint cysts Bone spurs Thickening ligaments in the spine because of spinal arthritis Injected steroids reduce inflammation and opens up these passages to provides pain relief. What are the risks of an epidural steroid injection? If you do have side effects, they may include: "Steroid flush," or flushing of the face and chest, with warmth and an increase in temperature for several days Sleeping problems Anxiety Menstrual changes Water retention In rare instances, pain that actually increases for several days after the procedure Serious complications are rare but can include: Allergic reaction Bleeding Nerve damage Infection Paralysis How do I get ready for an epidural steroid injection?
Tips for preparation include the following: An epidural steroid injection is generally an outpatient procedure. You may be asked to change into a surgical gown to make the injection process easier.
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