The Food and Drug Administration has just issued what’s called a Medwatch Alert warning that Epidural Steroid Injections or “ESIs” for back and neck pain can be extremely dangerous. The alert says: “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.”
ESIs are placed in your spine like an epidural for childbirth, but use different drugs.
They have become the most common procedure doctors do for low back pain, and considering 8 out of 10 Americans report low back pain at some point in their life, that is an enormous number of procedures. But what most people are not told is that it’s not FDA approved.
That’s right – not FDA approved. The steroids used in epidural steroid injections are FDA-approved only for your muscles and joints, but the FDA has never approved the injections for the spine, hip or other areas. Use of ESIs for anything other than muscles and joints is called “off-label use” – meaning that it never underwent an official study to make sure it’s safe and effective.
The saddest thing is that we still don’t know the scale of injuries and deaths due to ESIs because doctors are not required to report them.
Since the 80s steroid makers have tried to seek FDA approval, and that revealed one of its biggest dangers: steroids injected all the way inside the spinal cord could lead to a little-known condition called arachnoiditis, a condition that can be caused by any spinal procedure, including epidurals for childbirth. In arachnoiditis, the smooth, free-flowing fibers of the spinal cord wither and clump causing excruciating pain that arachnoiditis patients often refer to as “the pain of cancer without the release of death.” But the idea of using steroids to calm spinal inflammation lived on with serious consequences.
Studies show that epidural injections sometimes accidentally become intrathecal injections when doctors push the needle a little bit too deep. The margin of error is tiny.
In addition to arachnoiditis, other serious epidural steroid injection complications include meningitis, paralysis and death. Some of the steroids used in epidural steroid injections have a gritty, granular makeup, and if a doctor accidentally misfires the steroid solution into a patient’s artery, that can create a blockage, cause a stroke, and cause death.
Why would doctors risk your health and their careers on a procedure that carries significant possible risks? Critics say they do it for the money. Doctors can make as much as $2,000 for an ESI, which is only a 15 to 30 minute procedure. Some doctors spend just one weekend learning the delicate procedure at training centers that teach cosmetic injections like Botox and fillers.
Low Back Pain Means Bone Problems
While low back pain can be a problem of the joints, ligaments and muscles, it is also a signal of low bone density.
Studies show a link between low bone density and low back pain in men in their late 30’s and early 40’s. Other studies show that athletes with low bone density have more lower back problems.
If the degree of bone loss declines to the point of a compression fracture, the pain becomes severe and other problems set in. A compression fracture is a collapse of a vertebra. It may be due to trauma or, in people with very low bone density/osteopenia and osteoporosis, due to a weakening of the vertebra. Compression fractures which develop gradually, such as in osteoporosis, may initially not cause any symptoms, but will later often lead to back pain and loss of height.
Bone density measurement may be performed to evaluate for osteoporosis, and there are other preventative measures and alternatives to ESIs. They are:
Vitamin D: Some studies have shown patients back pain decreases as their vitamin D level increases. It’s estimated that 83% of people with chronic back pain have low vitamin D levels. Have your vitamin D levels tested and take vitamin D supplements, if needed, to get your vitamin D up to recommended levels. For bone density/bone health, that amount is 1,500 IU. (The majority of American women older than forty consume less than 200 IU/day).
Silicon: Silicon improves bone density by attracting calcium to bone, and silicon boosts calcium and Vitamin D bone benefits.
Vitamin K2: This form of vitamin K, and specifically a natural form called K2VITAL® improves bone toughness because it also helps bind calcium to bone proteins. Bone toughness and bone density are equal measures of good bone health.
Exercises: Resistance exercises can help to build bone density. Holding in a push-up position is one exercise that strengthens your back.
Patients should discuss the benefits and risks of ESIs with their health care professionals, along with the benefits and risks associated with other possible treatments. Regardless, taking better care of your bones is important to preventing fractures and may also decrease low back problems.