Benefits & Risks of Steroid Injections

[UglyGreed]

Back pain is the number-one reason people visit their doctors, and epidural steroid injections have been a mainstay of treatment for short-term pain relief for decades. The injections seem to be most effective for people who have "radicular" pain, or pain that radiates from the spine to a leg or an arm, caused by a herniated disk. Even so, relief is often only temporary, and injections should be limited to no more than two or three a year.

Experts aren't quite sure how worthwhile the injections are for other conditions since research findings from clinical trials are inconsistent. Because of the small number of high-quality scientific studies on epidural steroid injections, strong recommendations for their use are lacking.

The American Academy of Neurology's (AAN’s) guidelines state that "epidural steroid injections play a limited role in providing short-term pain relief for lower back pain that radiates down a leg and do not provide long-term pain relief." Specifically, they say that the average amount of relief is small and lasts only two to six weeks after injection. And, says the AAN, the injections don't "buy time: to avoid surgery.

Similarly, the American Pain Society suggests that epidural steroid injections may be used for radicular pain caused by a herniated lumbar disk, but the group falls short of strongly recommending them.


http://www.healthcommunities.com/back-pain/steroid-injections-benefits-risks.shtml

[UglyGreed]

1. More info from the FDA

FDA Drug Safety Communication: FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain


Safety Announcement
[04-23-2014] The U.S. Food and Drug Administration (FDA) is warning that injection of corticosteroids into the epidural space of the spine may result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death. The injections are given to treat neck and back pain, and radiating pain in the arms and legs. We are requiring the addition of a Warning to the drug labels of injectable corticosteroids to describe these risks. Patients should discuss the benefits and risks of epidural corticosteroid injections with their health care professionals, along with the benefits and risks associated with other possible treatments.

Injectable corticosteroids are commonly used to reduce swelling or inflammation. Injecting corticosteroids into the epidural space of the spine has been a widespread practice for many decades; however, the effectiveness and safety of the drugs for this use have not been established, and FDA has not approved corticosteroids for such use. We started investigating this safety issue when we became aware of medical professionals’ concerns about epidural corticosteroid injections and the risk of serious neurologic adverse events.1 This concern prompted us to review cases in the FDA Adverse Event Reporting System (FAERS) database and in the medical literature (see Data Summary).2-16

To raise awareness of the risks of epidural corticosteroid injections in the medical community, FDA’s Safe Use Initiative3 convened a panel of experts, including pain management experts to help define the techniques for such injections which would reduce preventable harm. The expert panel’s recommendations will be released when they are finalized.

As part of FDA’s ongoing effort to investigate this issue, we plan to convene an Advisory Committee meeting of external experts in late 2014 to discuss the benefits and risks of epidural corticosteroid injections and to determine if further FDA actions are needed.

Injectable corticosteroids include methylprednisolone, hydrocortisone, triamcinolone, betamethasone, and dexamethasone. This safety issue is unrelated to the contamination of compounded corticosteroid injection products reported in 2012.

http://www.fda.gov/Drugs/DrugSafety/ucm394280.htm

[UglyGreed]

2. Arachnoiditis

Arachnoiditis is inflammation of the arachnoid, one of the membranes known as meninges that surround and protect the nerves of the central nervous system, including the brain and spinal cord. The arachnoid can become inflamed because of adverse reactions to chemicals, infection from bacteria or viruses, as the result of direct injury to the spine, chronic compression of spinal nerves, complications from spinal surgery or other invasive spinal procedures, or the accidental intrathecal injection of steroids intended for the epidural space.[1][2] Inflammation can sometimes lead to the formation of scar tissue and adhesion that can make the spinal nerves "stick" together. This can be extremely painful, especially in last stage adhesive arachnoiditis


http://en.wikipedia.org/wiki/Arachnoiditis