The Safety of Epidural Steroid Injections: What You Need to Know 05/19/15
I have several posts explaining the dangers of epidural injections, but I’ve heard they can be very effective for a subset of patients. Here is an interview with a proponent of this treatment.
Q: What is an epidural steroid injection?
Dr. Richeimer: This procedure involves injection of corticosteroids into the epidural space around the spinal cord and nerves.
It is most often used to treat spinal disorders of the low back (lumbar spine), and also may be used to treat disorders in the neck (cervical spine).
Corticosteroids are believed to relieve low back pain by reducing inflammation.
Q: How effective are epidural steroid injections?
Dr. Richeimer: Studies are somewhat contradictory, showing different levels of response. Thus, we don’t have a clear understanding of how good this treatment is.
Some people get relief for years with 1 to 3 injections. On the other hand, some people only get relief that lasts a few weeks.
I wonder why he didn’t mention that a significant number of patients don’t get any relief at all, like me, and many are left in even greater pain.
In my opinion, there may be a less robust response in people with
- a more complex disorder,
- a longer duration of symptoms,
- surgery to the area, or
- more than one spinal diagnosis.
Q: Who is a good candidate for an epidural steroid injection?
Dr. Richeimer: Patients who respond best have low back pain with radiculopathy (nerve pain radiating down their leg) caused by a bulging or leaking disc, and have never had spine surgery in the area.
Epidural steroid injections may be used for neck pain (cervical spine) as well.
There is a growing consensus that the transforaminal approach (injection into the opening at the side of the spine where nerve roots exit) in the cervical spine is too risky of approach and should be avoided.
Yet this practice has not been stopped and will probably continue being done for decades – as epidurals have
The interlaminar (injection into the back of the epidural space) or midline approach (injection is made into the center of the epidural space) is preferred.
Q: What are the potential risks of epidural steroids injections?
Dr. Richeimer: Side effects may include
- an increased blood sugar,
- sleeping problems,
- water retention (bloating),
- facial flushing,
- infection, and s
- uppression of the HPA axis (a system in your body that controls response to stress and regulates many body processes).
Repeated use of epidural steroid injections may cause local osteoporosis (bone thinning) and weakening of the surrounding tissues that may cause further spinal degeneration over the years.
Severe side effects are rare, but may include an allergic reaction, infection, nerve damage, and paralysis.
I advise that multiple injections should be separated by at least a month or more and that no more 3 injections are given in a 6- to 12-month period.
Q: Are epidural steroid injections painful?
Dr. Richeimer: A local anesthetic is first injected into the area where the epidural injection will be placed, and often mild numbing/burning from the lidocaine is what people feel the most.
Of course, people with EDS may not respond to such conventional local anesthetics, so this has to be taken into account.
The majority of people tolerate this procedure without the need for anesthesia beyond the local anesthesia and without out too much pain.
Q: What should you ask your doctor before receiving a steroid injection?
Dr. Richeimer: You should ask and understand what approach your doctor is going to be taking—is it a midline approach or is it transforaminal?
It is advisable to ask your doctor why he/she is choosing a particular approach.
If your doctor is using a transforaminal approach, I think it is reasonable to ask the doctor to use preservative-free dexamethasone rather than a particulate steroid.
If you are considering such a treatment, please also read the warnings about it to make sure you’re aware of the risks:
- Update: Hidden Danger of Intraspinal Steroid Injections
- Spinal injections: comprehensive review of the literature (free full text PMC article)
You can find all posts with information on these procedures using the tag “epidural-injections“:
the author of the article missed some of the major complications: Death and paralysis. The steroids that are used in these injections generally come from “Compounding Pharmacies” and the larger ones are known as “Outsourcing Facilities.” In 2012 there was an outbreak of FUNGAL infections caused by contaminated steroids sold by New England Compounding Company in Massachusetts. The official tabulation is that nearly 800 people were sickened and 78 people were killed. The chief pharmacist and CEO are going on trial for MURDER next year.
Since that event, the FDA has been given authority to inspect these facilities and the FDA is reporting widespread evidence that these medications MAY produced in insanitary and some times conditios of “FILTH” (FDA’s Term).
Steroids as a class can also weaken connective tissue and any one with Ehlers Danlos should be especially leery of these interventions. the last thing an EDS patient needs is further weakening of the already abnormal connective tissue…..even if the medications are in fact sterile.
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