09 Oct The epidural meningitis crisis is a tragedy
As of Monday, October 8th, 2012 at least 8 people in the United States have died, and another 105 were struck with meningitis, after receiving an epidural steroid injection intended to treat chronic back pain. The tragic aspect is not simply that these people have died, but instead that the data that exists concerning steroid injections shows that they don’t solve the problem.
According to this report from 2009 in the Journal of The American Board of Family Medicine by Dr. Richard Deyo,
“The efficacy of spinal injections is limited. Epidural corticosteroid injections may offer temporary relief of sciatica, but both European and American guidelines, based on systematic reviews, conclude they do not reduce the rate of subsequent surgery. This conclusion is based on multiple randomized trials comparing epidural steroid injections with placebo injections, and monitoring of subsequent surgery rates.Facet joint injections with corticosteroids seem no more effective than saline injections.”
In other words, steroid injections are no more effective than a placebo. Given that there is a chance for doing harm with such injections, there is a serious question as to whether or not they should be given by medical professionals. The rest of the article points out similar stats about almost all of the other treatments for chronic back pain.
Jumps in imaging, opioid prescriptions, injections, and fusion surgery might be justified if there were substantial improvements in patient outcomes. Even in successful trials of these treatments, though, most patients continue to experience some pain and dysfunction.
If none of these treatments are leading to effective outcomes its hard to understand why their use is jumping exponentially. From a scientific point of view it seems that a totally new look at pain care is needed.