It is not so new that there have been strong concerns raised about epidural steroid injections for low back pain and other back conditions like disc herniations ("slipped" discs), radiculitis (nerve irritation), radiculopathy (nerve damage), spinal degenerative disease (arthritis), and stenosis.
The concerns that have been raised up to this point are for several reasons:
- RISK: Spinal epidural injections of cortisone (typically used) lead to a significantly increased risk of compression fracture. How significant of a risk? 20% increased risk of vertebral compression fracture after just one epidural steroid injection. On top of that, there are risks of infection, nerve damage, and bleeding.
- DAMAGE: Cortisone is a catabolic steroid. That means it works by breaking tissue down. in this way is is very effective controlling inflammation. The anti-inflammatory effect of cortisone is one reason people might feel better immediately after receiving an epidural injection. However, cortisone also degrades and breaks down normal bone, and soft tissue such as ligaments, tendons, muscle, and the attachment of soft tissues to bone. It also has a more systemic negative effect. The traditional medical thinking has been that limited exposure is acceptable, but the negative effects of cortisone is precisely why there is a limitation on the number of steroid a person should receive in a given time. Also, if the underlying cause of inflammation is not address, inflammation is typically recurrent.
- COST: Epidural steriod injections are expensive.
- POOR LONG TERM BENEFIT: Studies on epidural injections have shown that there is poor long term relief or benefit when compared to management without epidural injections.
So why do people get epidural steroid injections? Sometimes they just need some form of more heroic pain relief. Sometimes it is because they are being given narrowly focused care options. Less frequently, they have not other choice because their problem is not responding to other care approaches. But one thing is for sure, the frequency of lumbar epidural steroid use is skyrocketing in recent years, and the procedure is undoubtedly overused. And perhaps a more fundamental issue is that, even if an epidural steroid injection is necessary, it not enough to help over the long term.
In fact, the Annals of Internal Medicine (2015 Sep 1;163(5):373-81) recently again confirmed findings from prior studies:
" Epidural corticosteroid injections for radiculopathy were associated with immediate reductions in pain and function [short term pain relief]. However, benefits were small and not sustained, and there was no effect on long-term surgery risk. Limited evidence suggested no effectiveness for spinal stenosis."
NON-INVASIVE CARE ALTERNATIVES: While all of this sounds like I may be "anti-epidural", I am not. I am just realistic, and research and evidence-based. I have and will refer patients for epidural steroid injections when necessary. However, more reasonable options are considered first, and patients receiving epidurals are counseled on the risks -- as well as counseled about the real care that is needed afterward if relief is gained from an epidural injection. Our goal for patients is relief that leads to long term benefits in the fasted, easiest, safest, more complete, and least costly way possible. Maybe its time to see what natural care like modern chiropractic, cutting edge rehab, skilled massage therapy, active release technique, postural orthotics, proper self care recommendations, and other leading-edge care approaches can do.
If you are looking for reasonable and non-invasive, naturally effective care options if an epidural has been recommended for you, or if you are wanting proper care if you have already undergone an epidural procedure, give us a call. We have helped thousands of patients in the Tacoma, University Place and Fircrest areas over the years -- people just like you. Give us a call to see how we can help.