Thursday, January 5, 2012

Harms of Epidural Steroid Injections Examined

Injection A surge in epidural steroid injections to alleviate back and neck pain in the United States is bringing with it an increase in severe and unexpected complications, including paralysis and death, according to a report in Bloomberg News [here]. Nearly 9-million Americans received these interventional procedures during 2010 alone, and notices of serious adverse effects have prompted the U.S. Food and Drug Administration, in consultation with an advisory group, to review the safety of steroid injections into the epidural space near the spinal cord.

The FDA review comes during a boom in epidural steroid injections, which take minutes to administer and reap profitable reimbursements from Medicare and private insurers, the Bloomberg report observes. One study, by Laxmaiah Manchikanti, MD, chairman of the American Society of Interventional Pain Physicians (ASIPP), found the number of such injections among Medicare patients increased 159% between 2000 and 2010. Epidural injections are one of many interventional procedures — including implants of spinal cord stimulators — on which Americans spent $23 billion in 2011, up by 231% from 2002, the Bloomberg report notes.

The rise in epidural injections is being driven by two factors, the Bloomberg article claims:

  1. an aging population prone to back and neck pain, and

  2. generous reimbursements for interventional pain management procedures.

According to James Rathmell, MD — chief of pain medicine at Massachusetts General Hospital in Boston who alerted the FDA to cases of such injections causing harsh complications and is a member of the agency’s advisory group — “The problem with interventional pain is the majority of treatment is medical management. If you pay people to do stuff, they will do more stuff.”

David Armstrong, who authored the Bloomberg article, found that Medicare pays about $200 for a typical epidural steroid injection if given in a doctor’s office, roughly $400 if done at a surgery center, and about $600 if performed at a hospital. Some private insurers reimburse as much as 150% of Medicare rates. Meanwhile, the cost of the equipment, supplies, and staffing needed for a typical injection can be as low as $120.

The drugs used for epidural injection are anti-inflammatory corticosteroids, which are popular for easing pain in knees, hips, shoulders, and other parts of the body, in addition to the neck and back. The FDA review of epidural injections is being conducted by the agency’s “Safe Use Initiative,” a unit formed in 2009 to reduce “preventable harm” from medications. The focus of their investigation will be on steroid injections via the transforaminal approach, which brings a needle within millimeters of critical arteries feeding the spinal cord (also see explanation below). About half of the 8.9 million epidural steroid injections in the U.S. last year were administered using that approach, according to Manchikanti.

Another area of concern noted in the Bloomberg report is the use of particulate steroids. This form of the drug is slow to dissolve and may create blockages that trigger strokes if accidentally injected into arteries. Labeling of these agents specifies that they are not indicated for epidural use and that serious adverse events, including death, may occur.

At one time, serious adverse events with epidural steroid injections were thought to be rare or, at worst, relatively minor, such as headaches. “Then researchers and malpractice insurance companies began learning of cases of people becoming paralyzed and even dying after receiving the shots,” the Bloomberg report claims. A survey of physicians, reported in the journal Spine in 2007, revealed 78 cases where patients who received cervical injections suffered serious injuries; there were 13 deaths.

Additionally, an analysis by Rathmell and colleagues of malpractice claims between 2005 and 2008 identified 31 cases in which patients receiving cervical injections reported spinal cord injuries, and 8 who suffered strokes. In the analysis, Rathmell et al. called the cases “alarming” and said there is an “extreme dearth of evidence” about the safety of the injections.

Richard Rosenquist, MD, chairman of the pain management department at the Cleveland Clinic said in the Bloomberg article that part of the danger is due to the fact that almost any physician can give someone a spinal injection. “The unsuspecting public has no idea someone might have gone to a weekend course and on Monday morning is testing out their brand new skill on you. It’s horrible,” he stated.

Furthermore, the Bloomberg article observes that “Medicare patients receive transforaminal epidurals in a physician’s office more than any other setting,” according to a 2010 government audit. A third of those injections did not meet Medicare requirements — 13% because they were not deemed medically necessary and the rest because providers submitted bills lacking documentation as to why the injections were needed or improperly coded procedures. In some cases, according to the audit, multiple injections were given at close time intervals with no evidence that they were relieving pain.

How many injections are appropriate? According to the Bloomberg report, the North American Spine Society suggests a maximum of 4 injections within 6 months for cervical epidurals, but adds that setting absolute limits on the number could inappropriately limit some patients from receiving necessary care. Guidelines for pain management from the American Society of Anesthesiologists make no mention of how many injections are appropriate. The Mayo Clinic in Rochester, Minnesota, tells patients that injections are usually limited to a few annually because steroids can weaken spinal bones and nearby muscles and upset natural hormone balance, leading to potentially serious medical conditions. As might be expected, risks of side effects or serious adverse events might increase with a greater frequency of steroid injections.

COMMENTARY: In an UPDATE last September [here] we discussed an essay by Gerald M. Aronoff, MD, DABPM, claiming that the pain management field has been burdened by escalating interventional procedures that may be driven more by economics than better patient care. And, as a result of the ongoing turf wars between interventionists and medical practitioners, patients with pain are in danger of becoming collateral damage.

According to the Bloomberg News report described above, epidural steroid injections for neck and back pain are a burgeoning business. The injections are typically used to treat spinal stenosis, spondylolysis, herniated disc, degenerative discs, or sciatica and other spinal nerve entrapments. However, because the anti-inflammatory effects of the steroid agents, which are usually mixed with a local anesthetic, are short-term, the injections provide only temporary relief of pain, if any at all, and repeat procedures with their potential risks may be necessary.

Epidural-Injection Two approaches to the epidural space — inside the bony spinal canal but outside the dura mater enveloping the spinal cord — are commonly mentioned in the literature, interlaminar and transforaminal [see drawing]:

  • The interlaminar approach involves insertion of an injection needle into the epidural space midway between two adjacent vertebrae.

  • The transforaminal approach entails insertion of a needle into the intervertebral neural foramen (or, hole) where the nerve root exits the spine.

A third variation, used less often, is the caudal epidural steroid injection [not shown in the drawing] in which the needle is placed through a small opening at the base of the spine just above the tailbone.

In an excellent review of the literature comparing interlaminar versus transforaminal injections, Christopher Huston [2009] observes that wide variations in success rates with the interlaminar approach have fostered increased interest in transforaminal epidural injections, since these deliver targeted solution closer to the nerves generating pain. Huston claims that this approach is more effective than interlaminar or caudal injections and fluoroscopy-guided transforaminal injections have “emerged as the preferred approach to deliver steroids to the epidural space.”

However, because this approach also sends the needle so near to vital arteries, other practitioners believe the dangers of transforaminal approaches are too high. In the Bloomberg article, Manchikanti states that the transforaminal approach for cervical injections, in particular, has no role when considering the risks and that the organizatin he leads, ASIPP, has stopped teaching the technique.

Adverse effects of epidural injections have been poorly assessed in much of the research literature and are quite variable. Huston [2009] notes a long list of potential complications, including: dural puncture, nausea and vomiting, vasovagal reaction, facial flushing, fever, nerve root injury, pneumocephalus, epidural hematoma, subdural hematoma, Cushing’s syndrome, paresthesias, hypotension, non-specific headache, transient amnesia, increased pain, infection, respiratory insufficiency, transient blindness, epidural abscess, paralysis, spinal cord injury, cerebellar infarction, stroke, and death. He also notes that rates of the more transient or minor complications have variably ranged up to about 23%; although, there can be delayed reactions and complications days or weeks after the procedures that often go unreported in research studies. Incidence rates of catastrophic neurologic complications and death, while believed to be relatively rare, are unknown for certain.

Similarly, the degree of pain relief and its duration afforded by epidural injections also are highly variable, and appear to depend on numerous factors, including: the etiology of pain and its spinal location, specific solutions/mixtures and dosages used, administration technique, and the experience and skills of the individual practitioner. Large-scale, randomized, controlled clinical trials have been scarce, and the results of observational studies have been mixed, with both favorable and unfavorable outcomes.

Despite the concerns, Huston [2009] notes in his review that 40% to 85% of patients have successful long-term (more than 3 months) pain relief from transforaminal epidural steroid injections. This procedure also can be helpful to prognosticate potential success of surgery, if needed; patients who had 70% to 80% relief from transforaminal steroid injections were shown to experience greater than 95% success in achieving an average of 90% pain relief following surgery.

Often, however, outcomes comparing injection modalities in higher quality clinical trials are equivocal. Two very recently reported clinical trials exemplify this:

  • In a prospective, blinded, randomized trial of interlaminar versus transforaminal epidural steroids for subacute low back pain with radiculopathy [Gharibo et al. 2011], the transforaminal approach was superior in lowering pain ratings. However, on all other endpoint measures — disability, function, depression, and opioid use — there were no difference between the two techniques; both approaches were considered to be efficacious.

  • In a randomized, placebo-controlled trial of epidural steroid injections for chronic radiculopathy [Iversen et al. 2011], patients were injected caudally with either saline solution (placebo control) or saline + corticosteroid (active therapy), or subcutaneous saline (sham control). While there were small improvements in all 3 treatment conditions these did not reach statistical significance or differ between groups.

Each study had limitations and enrolled only carefully selected patients, which might have biased outcomes. The studies also were of insufficient size to assess the potential for adverse effects, which is a typical deficiency of research involving interventional pain management techniques.

Obviously, this is a topic worthy of much more thorough investigation. However, from the Bloomberg News report and the several other papers examined above, it seems evident that epidural steroid injections represent a growing area of interventional pain medicine that is laden with some concerns and controversies. While the procedures are very commonly performed for the symptomatic relief of a variety of pain conditions, they are temporary measures with many potential adverse effects, some more common and less serious than others. However, the need for repeated procedures to achieve ongoing pain relief also might increase the probability of adverse events occurring.

Currently, there appear to be some disagreements among experts, and conflicting clinical evidence, as to which anatomical approaches for injection are best, and there are a number of significant factors that can influence successful versus potentially harmful outcomes. Clearly, therapeutic decisions regarding epidural injection interventions should be pursued cautiously and with full consideration of benefits versus risks.

REFERENCES:
>
Gharibo CG, Varlotta G:, Rhame EE, et al. Interlaminar versus transforaminal epidural steroids for the treatment of subacute lumbar radicular pain: a randomized, blinded, prospective outcome study. Pain Physician. 2011(Dec);14(6):499-511 [
access article here].
> Huston CW. Cervical epidural steroid injections in the management of cervical radiculitis: interlaminar versus transforaminal. A review. Curr Rev Musculoskelet Med. 2009;2(1):30-42 [
access article here].
> Iversen T, Solberg TK, Romner B, et al. Effect of caudal epidural steroid or saline injection in chronic lumbar radiculopathy: multicentre, blinded, randomized controlled trial. BMJ. 2011;343:d5278 [
article here].

44 comments:

Anonymous said...

Your article presents excellent information. However I must challenge the myth perpetuated in the "Bloomberg article claims":specifically that "an aging population prone to back and neck pain".

I submit that CHRONIC back and neck pain is actually a disease of younger adults with onset when they are between 20 and 40 years of age. That is based on the numbers seen in my practice that was open for about 20 years.

It is unconscionable that so many "pain specialists" are making huge bucks while those who treat chronic pain sufferers with compassion and/or non-interventional means are going broke!

SB. Leavitt, MA, PhD said...

Thank you for the comments immediately above. I agree that we shouldn't think of these chronic pain disorders as being most common in older persons. This myth probably stems in part from the fact that researchers have easy access to the large, Medicare database in the U.S., which, of course, focuses on persons over age 65. There is no comparably extensive database for younger persons. -- SBL

M. Marden said...

I agree with the above comments...I am now a disabled nurse from spinal degeneration, rheumatoid arthritis. My condition started around the age of 35. I am now 54, and have to travel out of state for Interventional Spine Medicine, the best choice for care I have made. I am treated with a great deal of compassion.

Russ B said...

I am glad to see that the FDA is now actually doing a much needed examination of these procedures.
In 1978 I broke my back in the Army requiring a L4,L5,S1 fusion. The years since then have been filled with a lot more bad days than good. In 1986 I re-injured my back and this is when the steroid injections began. The first 3 or 4 helped, then I moved to a different state. I endured injections until the late 90s, none of these injections were under an x-ray machine, even worse some of them were done by interns. On 3 or 4 different occasions they ran the needle in an hit nerves going into my left leg, I thought I would die. These were all done at a Veterans Hospital except the first 12 were done at a teaching hospital right beside the VA Hospital.
To shorten this I do not understand why Medicare and Insurance Companies are so quick to pay for these high dollar procedures that have not been proven to help a spinal condition. Yet compassionate doctors who don't jerk out a needle every time you come in have a hard time getting paid beans for what they do. I praise God that I found a doctor who reviewed my records and has me on high dose opiate treatment but to be honest with you it is still not taking my pain below a 5-6. He fears being scrutinized by the DEA even though he has a file on me 6 inches thick. I am sure the pain is because of all the scar tissue and other things, but most of all I think it is from all the DAMAGE the injections did. Last but not least is the internal organ problems I am having now which my endocrinologist says is a direct result from the stress my body has endured because of the pain and the HIGH DOSE STEROID treatments I received.
Sorry this is so long

Dwight Ligham, MD said...

I think that spine related pain is complicated and usually involves several distinct and separate pain generators. The degree that radiculopathy responds to steroids depends upon whether symptoms are related to inflammatory as opposed to compressive irritation. In chronic pain PTS, injections have multiple indications: diagnostic, prognostic, and treatment. Frequently epidural injections resolve painful radicular exacerbations and restore the efficacy of medical and physical therapy. I do not think it wise to throw the baby out with the bath water by couching this discussion in economic terms. Risks and benefits must be weighed and an optimal path selected. I do not use the transforaminal approach In the cervical spine for steroid delivery. Although the efficacy seem better than translaminar, the risks are too great.

SB. Leavitt, MA, PhD said...

Thank you, Dr. Ligham. We always appreciate the insights and observations from practitioners in the field. -- SBL

Anonymous said...

Sue
I work as a medical assitant and have had several cervial injections but now am have all over pain. I just had one and could not sleep at night. I had so much pain in both my legs. I am conerned about what this is doing to the rest of my body. I have three herniated discs in my neck, also very painful. I am not elderly this is due to a car accident three years ago. Any advise would be appreciated

SB. Leavitt, MA, PhD said...

The comment immediately above is appreciated; however, I would like to remind readers that these UPDATES are not a place to seek or offer advice regarding individual medical conditions. --SBL

none said...

One possible side effect of epidural steroid injections that is almost always left out of an article, is adhesive arachnoiditis. Adhesive arachnoiditis is the swelling of the arachnoid membrane and the thickening, clumping, scarring, and adhesion of spinal nerves to one another, as well as to the dural sac. This condition causes intractable pain, as well as disability in many cases.

I have adhesive arachnoiditis. Whether it was caused by surgery or the many spinal injections I've had over the years, I will never know. I just know that I am in excruciating pain 24/7, and that my condition as well as its causes is not mentioned nearly often enough, especially when talking about epidural steroid injections.

Adhesive arachnoiditis has disabled me. It has flipped my life upside down, caused me to lose my job, my sense of security, and precious time with my family. It has also done this to many others.

I ask that you please mention this terrible condition next time you write about spinal injections. Many people would greatly appreciate it :)

Anonymous said...

For patient accounts of adverse reactions to corticosteroid injections (many of which are epidural), see: http://orthopedics.about.com/b/2008/10/11/side-effects-of-cortisone-shots.htm

It seems that in general, doctors are far too cavalier in administering these injections, irresponsible in not warning patients about side effects, and oddly, completely uneducated themselves about the side effects of the very drugs they routinely administer. Also see this paper on the topic: http://www.practicalpainmanagement.com/treatments/interventional/injections/understanding-potential-complications-epidural-steroid?page=0,0

SB. Leavitt, MA, PhD said...

Thank you, for the comment immediately above. That article in Practical Pain Management is certainly important reading. Here is an easy-click link to it
[CLICK HERE].

Anonymous said...

Although this paper is not about epidural injections, I think it offers valuable insight into the workings of corticosteroid injections in general: http://www.naturomedic.com/Portals/168760/docs/issue_02_deterioration_cartilage.pdf

Anonymous said...

I am currently 60 and was 95% paralyzed from my midsestion down on 1/28/12. That non trauma paralysis came as a total suprise that morning. In fact I felt the best I have ever felt in 30 years. I was taking pain shots 4 times a year plus for over 10 years to keep walking in airports for business or keeping active in old man sports. The prognosis was spinal infarction at T10, and later with my help spinal myleoplasm as they never found a troubled artery during a a full spinal angiogram which puzziled my Doctors at Lahey Clinic. Today 12 months later I have 50% use of my legs, 95% use of my bowels and the phantom nerve pain is still a battle. I hope to walk in 2013. I took a cortizon shot in late November prior to injury, and I experienced 80% more pain during the proceedure.....a day after I seem to be fine but the normal Lumbar pain in L4/5 never subsided. I was taking shots to C3 and L5 that year. I hope this helps for future research on pain shots. If anyone wants to do a case study on me call me at 508-320-8764. Thank You.......and PLEASE keep me updated on this subject.

Anonymous said...

Wow, all this could be avoided with non-force chiropractic, but they're still not considered a choice because of the AM slam campaign in the 60s - 80s...!

Debra Dicenso said...

Can anyone help me? I love this article by Bloomberg it's so true out here in California. I'm being extorted by my new pain doctor. He told me if I don't get epidural injections he will not give me my pain meds!! Wow, I've already had injections, surgeries...they didn't work. I now take pain meds. I didn't know in California you have to pay for part ownership in their private surgery centers. Can anyone tell me what to do, I'm going to be out of meds tomorrow and he refused me my medicine! What happened to "continuity of care"?PLease help, I'm scared and alone...

Anonymous said...

I've had lower back problems for several years and have been treated with epidural steroid injections with success over the last five years. Approximately 2-1/2 years ago, I had an injection and immediately experienced a new "burning" pain in my buttocks, backside of both legs and more prominent in both feet. I never had this pain before the injection. PM doc said it was impossible for the injection to cause my problem even though the onset was immediate. The pain has never left me and I deal with it on a daily basis. The only relief I get is when I lay down. Sitting, standing and walking aggravates the pain. My PM doc wanted to give me injections again 7 months after to provide relief for this new pain. Once again, the injections caused the burning pain in my buttocks, back of legs and especially feet to be worse than it was before. I've had two nerve conductive studies which were normal and a MRI which was inconclusive. Does anyone have any ideas - I'm exhausted with the daily chronic pain. Thank you.

Donna said...

I had a bilateral injection on March 20, since then I have been in horrendous pain 24/7 and with no relief. My bowels do not work, I haven't had a regular bowel movement since March 20. Most laxatives won't work. I am scheduled for a MRI on April 5 so hopefully they will find what is wrong with me. This all happened on March 20. Doctor was trying to cure my sciatica pain.
Now I am worse then ever.

Amy K said...

My husband is now 100% disabled vet. In Nov of 2008 they replaced his C6 vertebrae & are now waiting until C5 & C7 warrant replacement. As an active duty soldier, he was given Soma & Vicodin along with his other medications for PTSD. He has chronic pain, constant migraine headaches, photophobia (ocassional blindness), among other symptoms related to the cervical radiculipathy and neuralgia. Due to the clonazepam he takes for PTSD, the VA immediately discontinued the Vicodin because studies show some soldiers commit suicide while on this combination of medication. His VA PCM offered him morphine or physical therapy. This was a year ago. My husband was allowed 1 Soma every 24 hours & 3 vicodin and this combination was compiled by a pain specialist in 2011 when he refused the invasive injections and implantable stimulators. I can count on one hand the the number of times he maxed out his pain meds.
Anyway, he refused the morphine & tried the physical therapy/chronic pain team. Nice people, great team but they didn't prescribe meds because that was the PCM'S job. They did prescribe chiropractic care which provided him temporary relief & physical therapy which made him hurt worse. The PCM gave him some Tramadol because Robaxin causes stomach upset & when that didn't help they put him on Baclofen & Ultracet which are contraindicated. God Bless the VA, Ultracet comes as tramadol in one bottle and aspirin in another. He was to take the tramadol 3 tines daily & the aspirin 4 times daily. Problem is..my husband hates pills and knows that he is going to have to tolerate some pain. He only wants to treat his pain when it gets to a 4 or a 5. He doesn't want to be drugged continuously. The baclofen made him so dizzy that he could barely stand, let alone drive.
Back to the PCM, because he was willing to accept the morphine. Well, the VA is doing more studies on people with PTSD ....HE IS NOW BEING FORCED TO TALK TO A SPECUALIST ABOUT ESI & THEY HAVE THE FIRST INJECTION SCHEDULED.
In the meantime, the Dr did give him Soma. If he takes it, I refer to it as the "Soma coma" because it knocks him out. If he is in bad pain, but must drive somewhere, then he becomes angry, etc.
I would be more than happy to help the VA analyze a few of the other possible scenarios for the tragedies that some with PTSD suffer. For those that don't know what to do, advocate for yourself. My spouse doesn't have to go to this specialist on Wednesday, but he is. He will tell him NO to the injections but will attempt to discuss another route for pain control. If that does not work, we will see the Patient Advocate on Thursday instead of receiving the scheduled injection.
Thank you for the well written article with all if the cons we were looking for, but also a few pros.

Peter said...

Why wasn't Arachnoiditis mentioned in this article. Arachnoiditis is most commonly caused from epidural steroid injections, which I have been suffering since 2000. The steroid is not the problem, but the suspension these steroids are inside, such as benzyl alcohol and polyethylene glycol (better known as car antifreeze). If the suspension enters the sub-arachnoid space, just below the epidural space, Arachnoiditis most assuredly will be caused, which is a horribly painful lifelong disease. I had to have a quadripolar spinal cord stimulator implanted on my spinal cord, to help mask this awful burning, stinging, electric shock pain that runs from my waist to my toes, bilaterally, and has spread into my upper extremities. Steroid suspensions are NOT LICENSED OR APPROVED for epidural administration, as anesthesiologists and dolorists use these drugs "off label". Myelograms used to be the number one cause of Arachnoiditis, until MRIs were more frequently used to take imaging of spines, so that ESIs has now become the main cause of this awful disease. STOP getting ESIS! They are poisonous, they're being performed illegally and they DON'T ALLEVIATE back pain!

Anonymous said...

OMG!!! i wish i read this before i had my shots yesterday morning and now i feel like im about to have a baby.... he didnt give even anything for pain when i got relief from the hospital i cant take motrin my stomach gets upset and nothing similar to it whatsoever are this injection fda aproved?

Anonymous said...

I visited a local medical group for severe pain I was having in my right shoulder and upper arm (C5 radiculopathy). The two interlaminar steroid injections I received (the first between C6 and C7 and the second between C5 and C6) did nothing for the pain. In addition, I now have widespread pain everywhere in my body except for my left arm. I have not slept through the night in close to three months now, because the pain-management drugs (first Vicodin, then Percocet) did nothing for the pain I'm feeling. It is 24/7 and it is unabating. Today I visit a neurosurgeon because I've had it with modalities that don't work and, even worse, cause generalized pain that wasn't there before. I am desperate to get back to a semblance of normalcy in my life. More should be published on the side effects of steroid injections -- not only the life-threatening ones but also those that cause reactions such as I had.

Stella said...

I recently had an infection done July 19, 2013. I rested in bed for two days and followed doctor's order; about a week after, I felt like a lump in the upper part of my body and I could not hardly breath, I explained to my sister I could not breath something in my in my throat is causing me to not breath along with pain in my chest; I got up from the table walked and took short breaths. In going to my next appoint to the pain and neck center I explained to them I could not breath, I can't remember any thing being said or done. I explained to the nurse PR actioner that the treatment did not help, made me feel worse than I was before, she said sometime it takes more than one treatment. I told I did not want to be treated a second time until I feel better; then she recommended 4 weeks of physical therapy in which it took me over seven week before I started Physical therapy. I finally went to the hospital to check the pain I was having and I was told nothing much they could do but give me pain meds; I had to go back where I had the procedure and may it take several injection before I feel some relief. I wish I had read this before I took that injection. I still have that lump like sensation in my throat. At the base of my neck and the corner I have pain and like a bone some is sticking me. I also feel this at the starting point of my spine in the corner to the neck and connecting point. who can I see beside the pain and neck doctor?

Anonymous said...

DEA is to blame for the rise of injections too! They make it harder and harder for doctors to give proper pain medication to people who really need it! making them to want to keep trying injections etc. I now am sitting here suffering badly thinking of going to the hospital because an epidural has made me worse and in other areas. It is unbearable! medication does nothing! Let Governors, DEA agents etc. live in pain and be told sorry cant give you meds to stay out of pain or only a little!

Anonymous said...

It is so sad to read all these comments. 1.. These shots are VERY painful 2.. PM Drs really push the injections not just 1 but several . Need to tell you all the HEADS UP for the year 2014. More injections will be given because the Narcotics are NOT going to be given. I think its time for a UPRISE from the PEOPLE of the USA to step up. It is OUR BODY that is in PAIN not the FDA or DEA or GOV. Who are they to tell the PAIN PATIENT we are limited , or we can not have Narcotics .Cocktail - Injections that have not even been subject to Study !? I see a 150% increase in Medical Malpractice Law Suits before 2017. Bet

Anonymous said...

If a patient with a herniated disk in the neck is not responding to conservative treatments (PT, traction, painkillers, etc.) would your only recommendation be surgery? A doctor has suggested my husband receive cortisone injections (up to 3 in a year) but I can't understand why I would want to pay $3K for an injection if the pain relief is only temporary and there is a risk of the complications mentioned above (of course, there is a risk with surgery as well).

SB. Leavitt, MA, PhD said...

In response to Anonymous immediately above -- there are risks associated with any and all medical therapies. However, this is not the place for commentary on what may be best for individual patients, since proferring such advice would, itself, be risky and inappropriate.

Anonymous said...

If these injections only offer temporary pain relief, why do so many doctors push them on their patients? Simply because they are so profitable?

Anonymous said...

I have been living with 24/7 chronic back pain for the past two years now ever since my 2nd rear-end car accident by texting drivers left me with only 3 undamaged discs. My life is unrecognizable to me; as I'm sure it is for many of you that are suffering as I am. In my search to "get myself fixed"; I have consulted with two well-respected neurosurgeons that have both told me I would require numerous surgeries; a minimum of four was the best case scenario I received and no guarantee that the risks didn't outweigh the potential benefit. I am on my 4th pain management doctor now, which none of them have kept my pain under control to the extent that I could be productive and still earn a living and perform my wife/mother/daughter/friend activities except for the first doctor that prescribed four 10mg. percocets a day to me and then was shut down by the state of Florida. The second one prescribed me a blend of meloxicam/baclofen/gabapentin and I ended up being a zombie or asleep for over 20 hours a day. They also administered the steroid injections that even though I really couldn't feel much relief afterwards; I did feel the increased pain when they wore off. They would only give me 3 injections in one location and since I have so many damaged locations; it just didn't bring any noticeable pain relief because the other locations still hurt. Finally, I found a doctor that suggested starting with a series of bilateral injections in my L5 and then addressing my cervical and thorasic. I had my 2nd bilateral injections today and I got a pain in my left hip immediately; by the time I was 20 minutes on the ride home; eye-popping/crying/screaming pain was radiating down my left thigh, back of my left leg and into the heel of my foot. Also radiating into the groin area on my left side. We turned around and went back to the doctor; he told me it would go away in a few hours; he gave me a 60mg. shot of Toradol; I have put ice packs on it. I found this article because it is eight hours later and I am still in much worse pain than I was when I went for the injections. I wish I had of read this article before starting the bilateral injections. The lack of access to opiate pain therapy or medical marijuana therapy is ruining my life and I am afraid I am going to end up in a wheelchair. I am only 54 years old; I do not want to have to sell my beautiful home because I cannot afford my mortgage on disability income; I do not want to have to continue to expose myself to these highly risky injections, surgeries or an implanted neurotransmitter just so the DEA can thump their chests about shutting down pill mills. I can control the pills I take; I have no control over these injections; surgeries or implants. Anybody interested in organizing a grassroots campaign to fight back against the denial of access to opiate therapy and our constitutional right to the pursuit of happiness, please let me know how you would like to make contact.

kimmy said...

Just received my 2nd injection and I am still miserable. I just want to know has anyone experienced nausea and vomiting 3 days post injection. Or have had very uncomfortable cramping, like menstrual cramps?

Anonymous said...

I have chronic pain since april this year. After having a epidural shot my pain and movements got worse. I also noted that my leg pain got worse and also I cannot do kajel exersice urine just falls and I have no control. I'm not sure if it was due to shot or -----. Someone please help me understand.

Anonymous said...

B T McDermott
11/ 13/ 2013

May,2000 I fell and bulged L4/L5 disc. Back and rt leg pain that I experienced were severe. Surgery was suggested but I chose PT which helped a little. August,2000 I was injected and I had great relief. I worked as a construction worker and retired in May,2007.

April,2012 I was landscaping my yard and, after 6 days of hard work, my back pain reappeared. Again, a neurologist recommended surgery but I again chose PT which helped a little. August,2012 I was injected and again in 2 weeks. The injections eliminated the constant pain and I resumed my activities. When I stretch too far, lift a little too much or bend for too long I feel a strange pressure that tells me to "STOP DOING THAT".

The only side effect I can report is that I experienced a numbing of my penis, groin and rt butt cheek that lasted for 6 months. A small price to pay for the benefits. And I have avoided surgery.

Christine Pohl-Peters said...

I had my second injection last week. My first one gave me a horrific headache, nausea, fever, pain.. Everytime I stood up. Even my face throbbed. I called the office and they told me bed rest and caffeine. After a few days of that I was better.

Thursday I just had my second one. The doctor said I probably had a reaction to the dye and medication. I would most likely have it again. Well it is Sunday and I woke up this am with pain in my opposite side. It feels like it is in my hip and groin. The side which I got the injection is still sore. Had a burning stinging pain when I bent over.

The pain in the opposite side is in my back, side, hip and now leg. I had such bad pain with two herniated discs. So this was my option. I was debating on my second one now I am really worried about the third.

Toni Reisch said...

After numerous esi objections bilaterally to L3 with no decrease in pain I have had chronic itch in a 6 inch area on my left back. I was banned from that pain Dr because I told him he had to listen to me too after he played the God card on me.I went back to my previous pain Dr who immediately sent me to a neurosurgeon due to the MRI results the other Dr had done. I am scheduled for laminectomies to L3 and T 10 due to nerve root impingement. Seems he should never have given me ANY injections. My residual problem is a chronic itching to a 6 inch area around the upper lumbar injection site. What could be the cause of this? Steroids leaking into the tissue? What can be done for this?

worried said...

I had two injections so far. Herniated disc's of C2 C3 C4 C5 also degenerative . I had some very bad side effects like shakiness and nervousness. I started my period on Dec 23rd and have 3 menstrual cycles since. Currently still spotting. My neck pain has not gotten better what so ever. My face was flushed and broke out in terrible acne . I am only 38 years old and used to be very active with more energy than anyone I knew. Now I have absolutely no energy and I could sleep all night and I am completely exhausted when I wake up. Has anyone had any of these side effects? Very worried. .....

Christine Pohl-Peters said...

I wanted to follow up. I had my last steroid injection a week ago. I am still exhausted and my immune system is down. I had a fall and my injury had gotten infected. It still is healing.

The site of the injection is still really sore. Touching it feels like a bruise.

Today I am in a lot of pain. I feel so drained. I just want to keep sleeping.

I already have a few autoimmune illnesses so my body seems to have been weekened. I have been researching the steroid and the effects on the body. Had I not been in severe pain I would not have done it. It has really messed me up.

Including these neck headaches I didn't have before.

SB. Leavitt, MA, PhD said...

I am very sorry to hear about the complications noted by readers (above). However, I would again like to remind readers that these UPDATES are not a place to seek or to offer medical advice regarding individual health conditions or treatment complications.

Mevline Blackshear said...

I'm 43 years old and suffer from lumbar radiculapathy. Had first and only steroid injection on Feb. 24th. I felt confident it would work. It didn't. PM told me there was nothing else he could do for me. Now, I barely walk. Experienced symptoms of heart attack but after many test at E.R. determined it was Anxiety attacks. Searching now for Neurologist, hopefully they can help. So for now, I simply exist.

Christine Pohl-Peters said...

I am just glad I know I was not thinking I was wrong. The injection has really taken a lot from me. I do think more information needs to be done. I am seeing my pm doc on Monday. The pain is getting worse some days almost crippling. I find comfort in reading everyones stories.

chickensandcoke said...

So glad to read this. Just had my third set of shots each a week apart and 4 at a time. I have had different side effects after each set including insomnia, increased pain and headache the first time. 2nd set caused me to be extremely depressed and unable to find my way home from a surgeon appointment 2 days later. Waiting to see what happens with this third round although I have a headache starting to throb and I'm still not able to sleep, When I asked my PM Dr about side effects I had, he said they were not from the shots because they didn't occur same day as shots. I've missed ton of work, had to go on FML and my quality of life has changed drastically because if the pain. I have 2 herniated discs, lumbar stenosis and arthritis. I saw a surgeon to see if surgery would provide relief, but the surgery he wants to do, he said insurance won't cover. He can ease some pain though by cleaning out around my nerve or whatever he wanted to do, but I am out of paid sick leave to do even that. I am going to wait until I can build up more sick leave. My job is sitting 8 hours a day at a desk which isn't working out. Pain meds are too strong and I made errors at work could not concentrate or focus. Glad I was able to find others with same reactions to shots. I'm sure Dr is afraid of liability. My pain after shots usually gets better the day before I go in again so waiting to see if it does the same this time and because shot series is over, how long I have with less pain. Thanks so much for letting me vent. Most frustrating experience ever.

Dreamer#1 said...

My husband agreed to pain clinic steroid injection for his severe neck and left arm pain. Two weeks previous to the injection he Thad cateract surgery and the pain in his shoulder and necd was so severe he could hardly get through the eye surgery as he had to lay back and very still. So before the next cateract surgery he wanted to get relief from shoulder /neck pain. An MRI was schedued before the injection but he. Was Unabe to get the MRI because he could not lay flat and still because of the pain. Pain clinic did not care if thy had an MRI and said to go ahead with the steroid injection.
My husband described the experience of the shot as if being "electrocuted or tazed". He thought the experience lasted for 10 minutes or more. He could not talk and was completely out of control of his body with arms and legs flialing uncontrolably and having to be held down on table by nurses.
This cannot be a normal reaction.. nursing personel would not comment on his reaction to the injection but treated it as normal . Is this a normal reaction. He will never endure that again . This just happened two days ago so to soon to know if it will even hep.

Kyle said...

7 back surgeries, spinal stim in and out and countless injections like 30 plus. I have lots of scar tissue. I just had an epidural about 2 weeks ago and am still in way worse pain then when I went it, I am having mid low back and that stabbing from scare tissue more then normal and increased left check and left leg pain with crazy cramping and lwft food pain and numbness more left then right as well as bilateral intense inner thigh pain, Would love some feedback. of course I called the doctors office and asked to speak to him and they don't think it is needed, just some inflammation. He told me he had to punch through some scare tissue.. I am a little concerned this time around, something is wrong and after multiple stuff I know my body.

Kyle said...

I forgot I am suppose to go in for a sympathetic nerve block next week and this I will cancel it. The increase pain only makes me want to rethink the whole thing.

SB. Leavitt, MA, PhD said...

@Kyle (above) -- We are very sorry to read of your situation. However, this blog is not a place to seek advice regarding personal health issues and we will not allow posting in comments of such advice, which could be misleading or even harmful.

Crystal Petty said...

I had an injection Monday..It was horrible and now I can't stop vomiting.. I feel awful. The doctor acts like its all normal..