Ethics in Medicine

“Spinal” Steroid Shots Leading to Meningitis and Other Ills

Kristen Sparrow • October 15, 2012

“Not only were these people killed, but there was no ethical reason to give this treatment”
There has been an outbreak of meningitis cases linked to shoddily prepared steroids used in epidural steroid injections for pain.  This article discusses  some of the other dangers apart from these recent cases, such as ongoing nerve problems, paralysis, strokes and intractable pain, and arachnoiditis that can lead to bowel and bladder problems.  Apparently we’re seeing more problems because the use of these injections has increased because of aging boomers with pain, and, of course, the financial incentives to administer them.  I gave hundreds of these injections in my previous career as an Anesthesiologist, and was shocked in reading this article that epidural steroids were never sanctioned by the FDA!!  Furthermore, studies are inconclusive about the efficacy of these injections for pain control.

October 11, 2012

Before a Wave of Meningitis, Shots Were Tied to Risks


Perry D. Clark says that a steroid injected near his spine to relieve persistent back pain instead left him “way, way worse.” Twelve years later, he still suffers from continuous stinging in his legs and feet and occasional bursts of excruciating pain. “It’s like somebody took a hot poker out of a fire and jammed it into my foot for two or three seconds,” said Mr. Clark, a retired media professional from Petoskey, Mich. The outbreak of fungal meningitis that has killed 14 people and sickened 156 more has focused attention on the risk of infection from spinal injections. But the same injections have also long been linked to other rare but devastating complications, including nerve damage, paralysis and strokes. The Food and Drug Administration is already reviewing how to reduce the risk of “catastrophic neurological injuries” from the injections, said Dr. James P. Rathmell, chief of pain medicine at Massachusetts General Hospital, who is involved in the review. The risk of infections did not even factor into the review, though it will now, he said. The meningitis outbreak is raising new questions about the steroid spinal injections, which are given to millions of Americans. Use has mushroomed even as clinical trials have found only modest evidence that the injections help. Moreover, the steroids, while approved for uses like relieving inflammation in joints, have not been approved by the F.D.A. for epidural injections, next to the spinal cord. “Not only were these people killed, but there was no ethical reason to give this treatment,” said Dr. William Landau, a professor of neurology at Washington University in St. Louis, referring to those who died of meningitis. ..Dr. Manchikanti said his own review of Medicare records found an increase of nearly 160 percent in the number of injections from 2000 to 2010. The increased use is driven by the aging of the population, the desperation of patients and the desire of physicians to help — and there are financial incentives. Medicare and private insurers pay $100 to several hundred dollars for an injection, and there are pain clinics that do almost nothing but injections.