May 9, 2013

Safety of epidural steroid injections and Dr. Oz

On about May 7, 2013, Dr. Oz ran an episode on lumbar epidural steroid injections.   Dr. Oz criticized lumbar epidural steroid injections.  Dr. Oz did a major disservice                to the 2.9 million who watch his show daily.  His viewers are primarily women aged 25-60.  It is women aged 25-60 who make decisions about getting healthcare, including treatment for low back pain, so it is doubly unfortunate that Dr. Oz spread so much misinformation.

The steroids used in epidural steroid injections are not approved by the FDA for epidural use, although they are approved for injections into joints.  Given the experience we have with millions of injections being done safely, the epidural use of steroids should not be a concern.  We use medications routinely off-label.  Gabapentin, marked as Neurontin, is routinely used for neuropathic pain, such as peripheral neuropathy or post lumbar surgery syndrome.  Less commonly, we use Xyrem for sleep in patients with fibromyalgia.  So, the off label use of steroids should not be a concern.

There is also good evidence that injections without steroids, using just local anesthetics, are effective for treating low back pain.  If you don’t want steroids, just ask and we will not use them.

You should also know the risks of epidural injections.  Everything we do has risks, including injections.  These risks include infection, paralysis and death.  Before you get scared and decide not to have an epidural injection, put these risks in context.  You run the risk of death every time you drive a car.  Still, you get into the car confident that you will get where you are going safely.  Don’t let people going for ratings scare you.

Epidurals work for more than just pain in your legs from a disc bulge.  They also work for the pain from spinal stenosis, degenerative disease (arthritis) and from post lumbar surgery syndrome, whether just in the low back or also in the leg.

Epidural injections are a cost-effective, safe way of treating low back pain and leg pain (and also thoracic and cervical, or neck, pain) from disc bulges, spinal stenosis, post lumbar surgery syndrome and degenerative disc disease.  If you get more than 50% relief from an epidural injection, then a repeat injection makes sense to do, if you wish it.  You can have up to four injections a year, as long as you benefit from them.  For many people, there is no other therapy available to them.

Epidural injections should be done in combination with you exercising and keeping your core muscles, those in your abdomen and back, strong.  Other therapies, such as acupuncture, are also good.

I would very seldom recommend that you have an epidural injection before trying more conservative treatments, such as over the counter pain medications and exercise.

We at the Helm Center for Pain Management are committed to your safety.  We are deeply involved in efforts to make procedures safer.  Whenever we find a risk associated with a procedure, we look for ways to change how we do the procedure to make it safer for you.  This includes using needles which cannot inject into places we don’t want the injection to go.

We at the Helm Center believe that we offer more options and can provide better outcomes.  Those options and outcomes are based upon your safety and your ability to function better.  Call us if you have any questions.