Back Pain Shot Side Effects-Why Are We Putting Steroids in Epidurals?
POSTED ON 8/11/2014 IN Spine BY Christopher Centeno
Back pain shot side effects? The compounding pharmacy steroid tragedy of 2012 has left the news cycle. The contaminated steroids and the deaths and illnesses that followed brought the concept of an epidural steroid injection into the public eye. Now two years later, a new study shows that the steroids injected in those shots likely weren't necessary to help patients with sciatica.
A very common treatment for an irritated spinal nerve (sciatica) due to a disc bulge, herniation, or bone spur is injecting steroid and anesthetic into the epidural space. This is the area around the pissed off nerves. While the steroid in this procedure is a potent anti-inflammatory, it's injected into the low back in super-physiologic doses(about 1,000,000 times what your body would expect to see in that spot). These ultra-high doses of epidural steroid have been associated with bone loss in post-menopausal women. In addition, the compounding pharmacy tragedy of 2012 centered around steroid that was contaminated through being poorly compounded. What if after research showing side effects and the recent tragedy, the medical tradition of injecting the steroid didn't add anything to the effects of the injection?
A new study on this subject has been in process for years and has been periodically reporting it's data. The authors took 120 patients with sciatica and randomly assigned them to anesthetic plus saline or anesthetic plus steroid. At the end of two years, 65% of the anesthetic only group had significantly improved versus 57% of the anesthetic and steroid group. What's interesting is that this is one of many studies (study 1, study 2, study 3, study 4, study 5, study 6, study 7) now that show that adding in the mega-doses of steroids in common pain management shots does little to help patients over just the anesthetic. The upshot? If mega-dose steroids can inhibit healing and hurt the bones of women, they had better give much better results than just using the anesthetic in an epidural shot, right? However, this is not the way the medical research is trending right now. In fact, had we had this data 10 years ago, it's likely that the compounding steroid tragedy of 2012 would have never happened.
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