Joint Injections: Are They Worth the Risk?

Joint Injections: Are They Worth the Risk? | Medpage Today – Oct 2019

Patients no longer allowed to receive effective pain medications (opioids) may become desperate enough to allow these procedures despite the known dangers.

Intra-articular injections of corticosteroids for relief of the pain of hip or knee osteoarthritis (OA) may have adverse long-term consequences, researchers suggested.

I’ve been warning about this for years, especially when they are done near the spine: The Pain Industry’s New & Dangerous Fall-Back

You can see all my previous posts about this hazard using the tag epidural-injection. 

Pain clinics forced unnecessary injections on patients

Feds: Pain clinics forced unnecessary injections on patients to make millions – by Brett Kelman, Nashville Tennessean – Nov 2018

This is the nightmare scenario that was mentioned in my previous post: Epidural Steroid Injections: Danger Worth the Benefits?

Federal prosecutors have accused a chain of pain clinics spread through Tennessee, North Carolina and Virginia of duping the government and the military out of millions of dollars by forcing patients to receive unnecessary injections into their back, then intentionally mislabeling the injections during billing.

The allegations are spelled out in a lawsuit filed Friday against Pain MD clinics and parent company MedManagement, or MMi, both of which are headquartered in Franklin, Tenn.  

Epidural Steroid Injections: Danger Worth the Benefits?

Epidural Steroid Injections: Worth the Benefits? – By Christine Rhodes, MS – November 7, 2018

While most board-certified pain specialists offer epidural steroid injections (ESIs), the risks of these injections have been known for a long time.

They are successfully reaping profits from dangerous ESIs thanks to the CDC, which now seems to have taken over both pain management and substance abuse treatment from doctors.

With its vigorous opposition to the use of opioids and complete silence about the hazards of any non-opioid pain treatments, the CDC is practically endorsing any treatment that doesn’t involve opioids, even if it’s risky and/or ineffective.  

The Pain Industry’s New & Dangerous Fall-Back

Opinion: The Pain Industry’s New & Dangerous FALL-BACK – June 27, 2018 – By Dennis J. Capolongo / Director ENDC

From my perspective, preventative measures to reduce iatrogenic harm should be among the list of alternatives to help reduce opioid consumption.

Recently published reviews authored by outspoken physicians Dr. Martin Makary of John’s Hopkins and Dr. Jana Friedly of the U.W. Medical Center have pointed a finger at an industry that has literally run amok.

Here’s the other nightmare being foisted upon pain patients: “interventional” pain management, with needles and knives that leave patients in even more agony afterward.  

Neuroinflammation in spinal cord and nerve roots

Neuroinflammation seen in spinal cord, nerve roots of patients with chronic sciatica: Location of inflammation may determine which patients are successfully treated with steroid injections –  May 2018 – Massachusetts General Hospital

Another study showing that chronic pain is associated with distinct neurological variations.

A study by Massachusetts General Hospital (MGH) investigators has found, for the first time in humans, that patients with chronic sciatica — back pain that shoots down the leg — have evidence of inflammation in key areas of the nervous system.

In their paper published in the May issue of the journal Pain, the research team reports finding that average levels of a marker of neuroinflammation were elevated in both the spinal cord and the nerve roots of patients with chronic sciatica.  

Epidural Steroids Associated With Decreased Bone Density

Epidural Steroid Injections Associated With Decreased Bone Mineral Density, Increased Risk for Vertebral Fracture – Jessica Martin – January 25, 2018

Another reason to avoid epidural injections for pain:

In this systematic review and critical literature appraisal, researchers evaluated 8 studies (n=7233) that reported on the effects of epidural steroid injections on bone mineral density, osteoporosis, vertebral fracture, or osteopenia.

Across all studies, mean changes in bone mineral density ranged from 0.06% to 1.25% in the lumbar spine and from −2.87% to 0.45% in the femoral neck.  

Epidural Steroid Injections Overused

And yet another article on the overuse of epidurals, showing how they are being used to generate more profit for “interventional” pain specialists.

Experts Say Epidural Steroid Injections Overused — Pain News Network – August 19, 2015/ Pat Anson

Epidural steroid injections are being used too often to treat back pain, in part because of an insurance compensation system that encourages doctors to generate more income by using the procedure, several leading experts in pain management have told Pain News Network.

Critics say epidural injections are overused and patients risk permanent damage to their spinal cords if they get the shots too often. 

Beware of Worthless Procedures for back pain

Below is another article on the dangers of epidural injections. This procedure isn’t so popular because it bestows benefits on the recipient as much as because insurance companies compensate them so well.

Beware of worthless procedures and epidural steroids for your back pain – KevinMD – Cathryn Jakobson Ramin | Conditions | April 29, 2017

in a 2015 review of the medical literature, the Agency for Healthcare Research and Quality had found no evidence that epidural steroid injections were effective in treating symptoms of spinal stenosis or typical lower-back pain. 

Risks of Compounded Drugs

Potential Risks of Pharmacy Compounding – Drugs R D. – 2013 Mar – free full-text PMC article

Published reports of independent testing by the FDA, state agencies, and others consistently show that compounded drugs fail to meet specifications at a considerably higher rate than FDA-approved drugs.

Pharmacy compounding involves the preparation of customized medications that are not commercially available for individual patients with specialized medical needs. Traditional pharmacy compounding is appropriate when done on a small scale by pharmacists who prepare the medication based on an individual prescription.

the regulatory oversight of pharmacy compounding is significantly less rigorous than that required for Food and Drug Administration (FDA)-approved drugs; as such, compounded drugs may pose additional risks to patients.  

The Safety of Epidurals: What You Need to Know

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).