Excruciating back pain can make living seem impossible… After trying countless stretches, attending expensive yoga classes, eating anti-inflammatory foods, and even taking risky prescription painkillers, some back pain persists, making life miserable. Left with little to no other options, many people choose to get steroid injections, but they come with some terrifying risks.
In a forum on SPINE-health, one woman with pain in her lumbar spine described her first steroid injection:
“I don’t know what went wrong, as was told I’d feel a couple of bee stings, then maybe some pressure. I have a new scale for pain now, and on a scale of 1-10, it was 15. The most excruciating pain I’ve ever experienced. I passed out from it, and my blood pressure dropped to 78/52. They had to give me oxygen, smelling salts, wet towels, etc. They will NEVER do that to me again. Intensely painful and a nightmare.”
Another woman who received an epidural steroid injection for back pain in 2011 had a similar experience. Helen Bertelli, a mother of two from Raleigh, N.C., started feeling electric shocks, muscle cramps, and a sensation of water running down her legs.
“I had this feeling I was connected to the end of a guitar string and someone was plucking it. My legs just exploded like there were fireworks in them. My muscles twitched like they were boiling.”
All those scary symptoms make it seem like this supposedly pain-relieving procedure isn’t worth it, so…
How Do Epidural Steroid Injections Work?
Piercing pain in the back or neck is sometimes treated with epidural steroid injections (ESIs). A doctor will inject the epidural space (between the spinal cord and bony structure of the spine) with steroids. The injection is usually comprised of:
- Steroids or cortisone, the anti-inflammatory agent
- Lidocaine, a fast-acting local anesthetic
- Saline, to dilute the local anesthetic
On an x-ray table, the area of the patient’s back will be cleaned and numbed. Using a live x-ray, the doctor will guide a needle containing the steroid injection into the epidural space. When injected, the mixture is supposed to have an anti-inflammatory effect that can last anywhere from a few days to a few months.[4,5]
But because the epidural space is so delicate, this procedure can be extremely high-risk. And with so many epidural steroid injection horror stories out there, there are some things you should know about ESIs.
The Truth About Epidural Steroid Injection Procedures
On April 23, 2014, the U.S. Food and Drug Administration (FDA) released a warning to anyone considering or scheduled for an epidural steroid injection. The FDA’s warning even stated that they could “result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death.”
Because the potential side effects are so severe, the FDA ruled that all injectable steroids must carry an updated warning that included the risks above, including “arachnoiditis, bowel/bladder dysfunction, headache, meningitis, parapareisis/paraplegia, seizures, [and] sensory disturbances.”
Surprisingly, the FDA hasn’t actually approved steroids to be used in this way. This is largely due to the fact that research into ESI risks is still being conducted. But approved or not, Dennis Capolongo of the EDNC, a group that has campaigned against ESIs for years, believes that warning labels need to be stronger and more visible – not just confined to small print.
Capolongo compared the U.S. to Australia and New Zealand who, in February 2018, updated their warnings that such steroid injections “MUST NOT be used by the intrathecal, epidural, intravenous or any other unspecified routes.”
Are Epidural Steroid Injections a Viable Option?
Although ESIs are not the most natural treatment, there is no doubt that they have helped people over the years. For whatever reason, humans always tend to remember the negatives yet rarely the positives. However, researchers are still being funded to look further into epidural steroid injections as an effective and hopefully increasingly safe procedure.
A study in Pain Physician gave patients with lumbar spine pain (i.e., stenosis) epidural steroid injections. Although the sample size was small, patients were divided into two groups: mild to moderate pain and severe pain. When researchers observed the difference in pain relief after ESIs, they found that patients in both groups had reduced “pain intensity” scores. However, when compared against patients with severe pain, those with mild to moderate pain experienced a greater reduction in pain intensity over three months.
Research reports from the Archives of Physical Medicine and Rehabilitation have also shown that ESIs have been effective in relieving pain for patients with sciatica pain caused by a herniated disk. In one of them, almost half the group received a placebo injection. When researchers followed up with the other half who received epidural steroid injections, 80% of them expressed sciatica pain relief.
Another similar study gave ESIs to people with both sciatica pain and lumbar spinal stenosis. Amazingly, after one year of receiving their epidural steroid injections, three-quarters of the patients reported feeling 50% less pain. Many of them could even walk further distances and stand longer without experiencing pain.
So, although this may not be the lowest-risk procedure, promising studies do exist. Before agreeing to anything, however, please talk to your personal health care provider to see if epidural steroid injections are the best route for you. If you haven’t tried more natural alternatives such as sciatica stretches or eating an anti-inflammatory diet, you may want to give those a try first!
- Lumbar spinal injection horror story. Don’t read if you are scheduled for it. – Spinal Injections. (n.d.). Retrieved from https://www.spine-health.com/forum/discussion/52695/treatment/spinal-injections/lumbar-spinal-injection-horror-story-dont-read-if-you-are-scheduled-it
- James, S. D. (2012, October 25). Epidural Steroid Injection Risks Include Incurable Arachnoiditis. Retrieved from https://abcnews.go.com/Health/epidural-steroid-injection-risk-incurable-arachnoiditis/story?id=17552260
- Staehler, R. A. (n.d.). How Epidural Steroid Injections Work. Retrieved from https://www.spine-health.com/treatment/injections/how-epidural-steroid-injections-work
- Staehler, R. A. (n.d.). Epidural Injection Procedure. Retrieved from https://www.spine-health.com/treatment/injections/epidural-injection-procedure
- Epidural Injection. (n.d.). Retrieved from http://www.medcentral.org/Main/EpiduralInjection.aspx
- Center for Drug Evaluation and Research. (n.d.). Drug Safety and Availability – FDA Drug Safety Communication: FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain. Retrieved from https://www.fda.gov/Drugs/DrugSafety/ucm394280.htm
- Nelson, J. (2018, May 01). FDA Warns About Dangers of Epidural Steroid Injections for Back Pain. Retrieved from http://ushealthmagz.com/2018/05/01/fda-warns-about-dangers-of-epidural-steroid-injections-for-back-pain/
- Chang, M. C., & Lee, D. G. (n.d.). Outcome of Transforaminal Epidural Steroid Injection According to the Severity of Lumbar Foraminal Spinal Stenosis. Retrieved from http://www.painphysicianjournal.com/linkout?issn=1533-3159&vol=21&page=67
- May, B. (2018, February 13). Transforaminal Epidural Steroid Injections Effective for Pain Relief in Lumbar Foraminal Spinal Stenosis. Retrieved from https://www.clinicalpainadvisor.com/treatments/transforaminal-epidural-steroid-injections-pain-relief-radicular-pain-lumbar-foraminal-spinal-stenosis/article/743625/
- Lutz, G. E., Vad, V. B., & Wisneski, R. J. (1998, November). Fluoroscopic transforaminal lumbar epidural steroids: An outcome study. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9821894
- Botwin, K. P., Gruber, R. D., Bouchlas, C. G., Torres-Ramos, F. M., Sanelli, J. T., Freeman, E. D., . . . Rao, S. (2002, December). Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis: An outcome study. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12447088
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