The tragic occurrence of meningitis, stroke and death following use of infected steroids used for spine injections should make us more aware that this very common treatment for back pain may not be worth the risks. The use of epidural steroid injections (ESIs) to shrink an inflamed nerve thought to be causing back pain has not been shown to consistently reduce pain and even when it does the benefit is frequently short-lived. Aside from infection, other rare but serious side effects include bleeding that can cause nerve damage with possble weakness and paralysis, and additional pain. Steroids themselves have been the cause of bone (aseptic necrosis) and tendon damage.
Multiple medical professional organizations have suggested that ESIs should not be used for long standing back or neck pain or for pain in the back or neck that does not radiate to the arms or legs. Despite the evidence that even when ESIs reduce or eliminate pain, at best they are useful for 3 months or less. Other countries i.e. Denmark, rarely use ESIs.
As long as a thorough physical examination does not take place with all patients complaining of back or neck pain, with the purpose of determining if muscles are a source of pain, we will continue to rely on imaging studies that lead us to mistakenly believe that all back pain comes from the spine and the nerves leaving the spine. Continuing to provide unnecessary and ineffective treatments not only squanders our limited resources but could cause irreparable harm.
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