Patients wise to question spinal shots

Dr. Daniel Kim, the founder of the Southern Nevada Pain Center, is concerned about all the phone calls his office receives from people worried about whether they should receive epidural spinal injections for back pain.

He wants to set their minds at ease.

Whether he, or anyone else connected with a pain center, can ever do that is questionable.

What the good doctor basically suggests as a way of calming people down is reiterating that most Nevada pain clinics do not do business with the Massachusetts compounding pharmacy that is accused of developing contaminated injection medication that is now linked to the deaths of 23 people and more than 300 confirmed infections of fungal meningitis.

But that shouldn't calm people down. No, knowing that federal officials confiscated five unused vials of the medication from one Las Vegas clinic shouldn't stop people from questioning both the safety and the efficacy of spinal injections.

Nor should it stop them from demanding more regulatory authority over health care, particularly not when Kim himself says there is an "overutilization" of injections by some doctors who seem more interested in profits than patients.

Consider:

Before the present crisis, the Food and Drug Administration was already reviewing how to reduce the risk of catastrophic neurologic injuries, such as paralysis and death, from the injections received by millions of Americans.

Although the British Medical Journal reported in 2011 that in a blind study patients received as much pain relief with saline placebo shots as those who got epidural steroid injections, Washington state officials found last year that for one set of circumstances, there were seven clinical trials showing injections helpful, another seven finding them no better than a placebo.

In 2009 The Journal of the American Board of Family Medicine reported that the injections "do not reduce the rate of subsequent surgery," and also pointed out that Medicare claims for injections rose 271 percent during a seven-year period and "charges per injection rose 100 percent." Injections now run as much as $600.

Although doctors can prescribe drugs for unapproved uses, the steroid injections, while approved for uses such as relieving inflammation in joints, have not been approved by the FDA for injections next to the spinal cord.

Pfizer Pharmaceutical, which developed Depo-Medrol, the drug most used for the epidural injections, does not condone the use of the drug for epidural injections.

Though noting that the rate of serious complications from injection procedures is impossible to estimate because of the lack of mandatory reporting, the American Society of Anesthesiologists reported last year that epidural injections accounted for 40 percent of all claims involving pain management cases over a 20-year period, and forecast far more future serious injuries.

Although some researchers peg the chance of serious complications from epidural injections at one in 10,000, a survey of 287 physicians published in 2007 in the journal Spine found they had 78 serious complications and 13 deaths from giving injections.

To his credit, Kim admits that his concern about a public concerned about injections stems partly from this fact: His business is falling off now that people are worried about the shots.

Kim says injections should not be marketed as a quick-fix first response, but seen as a last resort, after patients in pain have tried anti-inflammatory medications and physical therapy. He also said shots are most useful for people with acute back pain, offering temporary relief for people who have, for example, herniated disks, where pain radiates down the leg.

What is troubling is that the journal Spine reported in 2007 that more than half of the people receiving injections are those who have the kind of chronic back pain brought on by obesity, where the shots are of little or no use.

"There's no question that if people lost weight and exercised many would have less back pain," Kim says. There's also no question, Kim says, that some doctors haven't been adequately trained to administer the shots.

If your mind is now at ease about the safety and efficacy of epidural spinal injections, chances are you just finished your second double shot of Wild Turkey 101.

Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.