Pain like a "hot poker out of a fire," nerve damage, strokes, paralysis – these are the complications long linked to the same epidural steroid injections that are now blamed for the recent meningitis outbreak.
At the time the outbreak began, the Food and Drug Administration (FDA) was already reviewing how to reduce the risk of "catastrophic neurological injuries" from the injections, and now the risk of infection will be added to their review.
Use of the injections has skyrocketed in recent years, growing by 160 percent from 2000 to 2010. This is despite the fact that clinical trials found only modest evidence that the shots are effective in treating pain. In addition, the steroids have not been approved for use by the FDA for epidural injections, which are administered next to the spinal cord.
Pain specialists argue that doctors are allowed to prescribe drugs for unapproved uses and that the injections carry less risk than narcotics or surgery. Some do concede, however, that the injections are overused. They are most effective in people with herniated discs and pain that radiates into the arms and legs. A study published in 2007 found that that fewer than half of the injections given were for these ailments, and that 20 percent of the doctors who perform the injections weren't properly trained.
Epidural injections are administered into the epidural space that is right outside of the spinal column. In some cases the needle misses its mark, injecting the drug into the spinal fluid or arteries. This can cause nerve damage, hemorrhages, and death to nerves. Another complication is arachnoiditis, an inflammation of a membrane that surrounds the nerves of the spinal cord. It causes pain, nerve damage, and bowel and bladder dysfunction.
The FDA is currently developing better practices for injection techniques in the hopes of reducing the risk of injury.
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