DR. WAYNE M. FICHTER JR.: Do epidural corticosteroid shots work?

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We often get asked about our thoughts on steroid injections. So I decided to look at the latest research and share the information with you so you can make an educated choice.

Analyzing results from nearly two dozen clinical trials on thousands of patients, Australian researchers found that epidural injections (into the spine) of corticosteroids had no long- or short-term effect on sciatica back pain, and such a small short-term effect on leg pain it would make no difference to the patient.

“I think it’s pretty clear that this treatment is not good to do,” said Chris Maher, of The George Institute for Global Health in Sydney, Australia, who worked on the study.

Nonetheless, the use of epidural steroid injections to treat back pain of all sorts among Medicare patients nearly doubled from 741,000 in 2000 to about 1,438,000 in 2004, according to the researchers. Charges per injection have risen 100 percent during the past decade, and the combination of increasing rates and charges has resulted in a 629 percent increase in fees for spinal injections.

Back pain is the No. 1 reason people visit their doctors, and epidural steroid injections have been a mainstay of treatment for short-term pain relief for decades.

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.

In April 2014, the U.S. Food and Drug Administration (FDA) issued a warning that the “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.” According to the FDA, drug labels of injectable corticosteroids are required to carry a warning describing these risks.

A retrospective study in the June 5 issue of the Journal of Bone and Joint Surgery looked at one type of back treatment — a lumbar epidural steroid injection and whether or not that treatment had an impact on bone fragility and vertebral fractures (spinal fractures). A higher number of injections was associated with increased risk. Authors concluded that LESIs may lead to increased bone fragility over time, and while injection therapy is useful in some cases, it should be approached cautiously for patients at risk for fractures associated with osteoporosis.

“In general, I think we’ve learned over the years that the epidural injections are turning out to be less and less successful… but there are times when they should be considered,” said Dr. Kirkham B. Wood, chief of the orthopedic spine service at Boston’s Massachusetts General Hospital.

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Dr. Wayne M. Fichter Jr. is a chiropractor at Natural Spine Solutions. The business is located at 3913 Schreiber Way in Coeur d’Alene. (208) 966-4425.

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