Epidural steroid shot pain treatment debated amid meningitis scare

[Emily]

http://www.usatoday.com/story/news/n...-+Flipboard%29

Epidural steroid shots debated amid meningitis scare
Duane Marsteller, The Tennessean
6:16AM EST October 6. 2012 - NASHVILLE -- As authorities continue to focus on a potentially contaminated steroid as the source of a widening outbreak of fungal meningitis, some patient-safety advocates are calling for greater restrictions on the type of injection involved.

They say epidural steroid injections, like the ones given to the meningitis victims, are far too dangerous and should be limited or even banned. But those who give the injections say they are safe when done properly and note the current outbreak appears to have originated from the medicine, not the procedure itself.

The debate was being waged long before the meningitis outbreak began with the Sept. 17 death of a 78-year-old man in Nashville....

[mixin]

Re: Epidural steroid shot pain treatment debated amid meningitis scare

The New York Times has an informative article: Scant Oversight of Drug Maker in Fatal Meningitis Outbreak

It discusses a number of issues associated with compounding pharmas.

http://www.nytimes.com/2012/10/07/us/scant-drug-maker-oversight-in-meningitis-outbreak.html?pagewanted=all&_r=1&

The Times article also quoted the Cochrane review: Injection therapy for subacute and chronic low-back pain

[snip]

Main results:
18 trials (1179 participants) were included in this updated review. The injection sites varied from epidural sites and facet joints (i.e. intra-articular injections, peri-articular injections and nerve blocks) to local sites (i.e. tender- and trigger points). The drugs that were studied consisted of corticosteroids, local anesthetics and a variety of other drugs. The methodological quality of the trials was limited with 10 out of 18 trials rated as having a high methodological quality. Statistical pooling was not possible due to clinical heterogeneity in the trials. Overall, the results indicated that there is no strong evidence for or against the use of any type of injection therapy.

Authors' conclusions:
There is insufficient evidence to support the use of injection therapy in subacute and chronic low-back pain. However, it cannot be ruled out that specific subgroups of patients may respond to a specific type of injection therapy.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD001824. DOI: 10.1002/14651858.CD001824.pub3

The rest of the abstract can be found here

http://summaries.cochrane.org/CD001824/injection-therapy-for-subacute-and-chronic-low-back-pain