Millions of Americans suffer back and neck pain and billions of dollars are spent every year on treatment. When spinal pain becomes serious or disabling, doctors often prescribe a corticosteroid injection near the spine (an epidural). In 2011 alone, almost 9 million epidural steroid shots were administered. But the effect was not always an improvement.
In some cases, patients suffer paralysis, incontinence, stroke and even death. A survey of doctors, published in the medical journal, Spine, found 78 cases in which patients who received a steroid injection in the neck suffered serious injuries; 13 patients died. An analysis of medical malpractice claims between 2005 and 2008 revealed 31 spinal cord injuries and 8 strokes.
A review of the safety of epidural shots is being undertaken by the FDA and other researchers. There are four areas of possible treatment errors:
- The type of procedure: In particular, researchers are examining whether transforaminal shots, in which the needle is extremely close to arteries that supply the spinal cord, is problematic. Half of all epidural steroid shots are delivered this way.
- The type of steroid: Particulate steroids, such as Kenalog and Dep-Medrol, are slow to dissolve and may create blockages if they get into the arteries.
- The qualifications of the medical professional: Almost any doctor can give someone a spinal injection. In a hospital setting, the doctor will have undergone review, but many epidurals are given in a doctor's office and that doctor may or may not have had any special training.
- The number of shots: There are no universal guidelines regarding the number of epidural injections that should be administered within a given time frame. The Spine Society suggests a maximum of four in a six month period in the case of neck pain, but a review of insurance data found one patient who had been billed for 51 injections in a year's time and another who had had 13 in five months. (In that case, the man had filed a medical malpractice lawsuit claiming the shots caused kidney failure.)
What is clear is that corticosteroid shots are not as safe as many patients have been led to believe. In order for a patient to give informed consent, he or she must be told of these risks.
Source: Business Week, "Epidurals Linked to Paralysis Seen with $300 Billion Pain Market," by David Armstrong, January 12, 2012.