The national news has not been good of late for those who have received a common treatment for acute low back pain. A tainted batch of medication has resulted in 15 deaths to date with more than 200 people falling prey to this potentially deadly form of fungal meningitis. It is estimated that at least 14,000 people are now known to have received these contaminated epidural injections. Patients in states as close as Tennessee and Virginia have now been confirmed as having fungal meningitis.
Epidural steroid injections (ESIs) are a common medical treatment for many forms of low back pain and leg pain. They have been used for low back inflammatory conditions since the early 1950s and are still an often-used part of the non-surgical management of low back pain, sciatica (leg pain) along with neck and arm numbness/tingling and pain. The goal of the injection is pain relief.
Doctors of Chiropractic are physicians who see a large number of patients who have back pain, and may have had spinal epidural injections for their pain. Our office has been watching patients who have had recent spinal epidurals to see if they are at risk. If you have had an epidural steroid injection, please be aware of these facts:
- The potentially contaminated injections were given starting May 21, 2012.
- Symptoms present themselves approximately one to four weeks following injection.
- Most patients’ symptoms were initially very mild.
- Symptoms associated with the outbreak include fever, new or worsening headache, nausea and new neurological problems.
- Fungal meningitis is rare and is non-contagious.
- The treatment for fungal meningitis is prolonged and costly.
Most doctors will agree that the effects of an epidural steroid injection tend to be temporary—providing relief from pain for one week up to one year—and the procedure is expensive, with an cost in the neighborhood of over $1,000 for each shot. There are risk factors beyond the recent outbreak of fungal meningitis. A 2007 survey of physicians reported in the journal Spine uncovered 78 cases where patients who received the epidural shots in the neck suffered serious injuries, including 13 deaths.
Aside from offering only temporary pain relief, the fundamental problem with epidural steroid injections is that they do not change the underlying cause of most back pain: joint dysfunction. Considering there are upwards of 137 joints in the spinal column and that chiropractors are uniquely qualified to manage joint dysfunction, it’s not surprising that chiropractic care works so well.
Every international guideline on low back pain now recommends conservative care like chiropractic before drugs, shots, or spine surgery for the majority of back pain cases. Evidence-based guidelines recommend this paradigm shift in spine care, but seem to have had little impact on actual primary care practices.
According to Hans-Christoph Diner, M.D., Ph.D., “Our advice should be to stay with conservative treatment like regular exercise, physical therapy/chiropractic care, and, if necessary, take NSAIDs and seek behavior therapy.”