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Epidural Steroid Injections: Are long-term Risks Worth Short Term Benefits?

By |January 5, 2014|Iatrogenic Injury, Steroids|

Epidural Steroid Injections: Are long-term Risks Worth Short Term Benefits?

The Chiro.Org Blog


SOURCE:   ACA News ~ February 2014

By William Morgan, DC


Outpatient procedures are where the money is in medicine these days. Such procedures are invasive treatments that are not quite surgery but are not conservative care either. Non-surgical procedura lists are falling over themselves at an alarming rate to learn these lucrative businesses. This is true in several medical specialties: cardiac catheterization labs, GI endoscopies and colonoscopies, interventional radiology procedures, PMR pain procedures, urologic cystoscopies, chiropractic manipulation under anesthesia, epidural steroid injection therapies and many other pain procedures. If utilized correctly, these procedures may be valuable tools in the treatment of patients by preventing more invasive procedures, and in the case of cystoscopies and colonoscopies, aid in the early detection of cancer.

These procedures can be done quickly with assembly line efficiency and are very profitable for the physicians. In the case of epidural steroid injections (ESI), a ten-minute epidural procedure will generally yield anywhere from a couple hundred to a couple thousand dollars, though I have heard of a series of three epidurals going for as much as $8,000. Furthermore, if done in an outpatient facility, the physician does not have to split the fees with a hospital, and the insurance company does not need to pay the higher costs that normally accompany hospital-based procedures. Last year in the United States, the Centers for Medicare and Medicaid Services (CMS) paid for nearly nine million ESI. This number may not appear surprising at first, but when you consider that ESI therapies are neither approved by the FDA [1] nor recommended by the manufacturers [2] due to reports of severe adverse events, it becomes alarmingly relevant. Note that the CMS number is not the total number of ESI performed in the United States. The nine million number represents only those ESI paid for by CMS. When we add in the number of ESI performed in the DOD, VA, workers’ compensation systems and private insurance, that number could conceivably be in the tens of millions.

While it is true that ESI are not FDA approved, Medicare, Medicaid, workers’ compensation and most other insurers continue to pay hundreds of millions of dollars per year for this controversial procedure.

Ironically, on every vial of Kenalog (a popular steroid used for epidural injections) there is actually a warning against its use for epidural injections, yet proceduralists continue to use it.

There are more articles like this @ our:

The Iatrogenic Injury Page

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More Bad News For Low Back Pain Sufferers: Drug-induced Meningitis

By |October 4, 2012|Iatrogenic Injury, Low Back Pain, Steroids|

More Bad News For Low Back Pain Sufferers:
Drug-induced Meningitis

The Chiro.Org Blog


SOURCE:   Associated Press ~ Oct 4, 2012

By MIKE STOBBE


Medication Linked to Meningitis Deaths May Have Reached 23 States

The potential scope of the meningitis outbreak that has killed at least five people widened dramatically Thursday as health officials warned that hundreds, perhaps thousands, of patients who got steroid back injections in 23 states could be at risk.


UPDATE: October 09, 2012: The number of identified cases has reached 119, with 11 deaths in 10 different states.


UPDATE: October 11, 2012: The number of identified cases has reached 170, with 14 deaths in 11 different states.


UPDATE: October 12, 2012: from MedScape The number of people exposed to potentially contaminated methylprednisolone acetate produced by the New England Compounding Center (NECC) in Framingham, Massachusetts, is closer to 14,000 — not 13,000 — as originally reported on October 8, federal health officials said today.

“These 14,000 patients received the medication as a steroid injection either into the spinal area or into a joint space such as a knee, shoulder or ankle,” said J. Todd Weber, MD, incident manager of the multistate meningitis outbreak at the Centers for Disease Control and Prevention (CDC). More than 12,000 of these people have been contacted to date, he said.

As of today, the CDC said a total of 170 cases (including the 14 deaths) have been reported across 11 states: Florida (7 cases, 2 deaths), Idaho (1 case), Indiana (21 cases, 1 death), Maryland (13 cases, 1 death), Michigan (39 cases, 3 deaths), Minnesota (3 cases), New Jersey (2 cases), North Carolina (2 cases), Ohio (3 cases), Tennessee (49 cases, 6 deaths), and Virginia (30 cases, 1 death).


UPDATE: October 25, 2012: from MedScape There are currently 328 reported cases of fungal infection, with 24 deaths now reported in 18 states. This includes 5 peripheral joint infections.


UPDATE: November 27, 2012: from Fox News There are currently 510 reported cases of fungal infection, with 36 deaths now reported in 19 states, and another 14 cases of peripheral joint infection reported.

NEW YORK (AP) — The potential scope of the meningitis outbreak that has killed at least five people widened dramatically Thursday as health officials warned that hundreds, perhaps thousands, of patients who got steroid back injections in 23 states could be at risk.

Clinics and medical centers rushed to contact patients who may have received the apparently fungus-contaminated shots. And the Food and Drug Administration urged doctors not to use any products at all from the Massachusetts pharmacy that supplied the suspect steroid solution.

It is not clear how many patients received tainted injections, or even whether everyone who got one will get sick.

So far, 35 people in six states — Tennessee, Virginia, Maryland, Florida, North Carolina and Indiana — have contracted fungal meningitis, and five of them have died, according to the Centers for Disease Control and Prevention. All had received steroid shots for back pain, a highly common treatment.

This is especially disturbing, because

Steroid Injections Offer Minimal Relief for Lower Back Pain

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