Chiropractic Works with Dr. Birk

Another Warning! Epidurals and Back Pain

Posted: May 24, 2017
By: Dr. Ruminder Birk

In the past I have written about how reconstructive care has provided excellent results in comparison with other standard treatments for back pain, and without the potentially harmful side effects. Disk herniation, for instance, is usually dealt with in one of three ways in standard medical care: minor problems are usually prescribed non-steroidal anti-inflammatory drugs (NSAIDS); epidural steroid injections may be employed in more serious cases; and, in the most severe cases, disc problems may be treated with surgical intervention, such as lumbar fusion.


Each of these treatments has concerns about long-term side effects that are well documented but rarely made clear to the patients. However, earlier last month we had another warning about epidurals that is unambiguous.


Epidurals are injections of cortisone directly into the spine near to the location of the pain, and they have been used for decades. They typically have good results in the short-term management of pain, but there have long been question marks over their side effects, especially in relation to weakening of the bones.
A US study published in The Journal of Bone and Joint Surgery in 2013, analysed patients with vertebral body fractures following lumbar epidural steroid injections (LESIs). It concluded the following:

'In the survival analysis, an increasing number of injections was associated with an increasing likelihood of fractures. Each successive injection increased the risk of fracture by a factor of 1.21.'

The increased bone fragility and fracture risk can be a significant problem, especially in the elderly and others at risk for osteoporotic fractures. But last month's warning went further.

New FDA Warning
At the end of April, The U.S. Food and Drug Administration (FDA) published a more serious warning about the potential side effects of epidurals:

'Injection of corticosteroids into the epidural space of the spine may result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death.'

Corticosteroids will therefore have to carry a Warning label detailing the risks. The FDA advises the following:

'Patients should discuss the benefits and risks of epidural corticosteroid injections with their health care professionals, along with the benefits and risks associated with other possible treatments.'

The Sane Solution
Any medical professional is unlikely to recommend spinal re-constructive care, but it has been proven to provide relief from back pain without the adverse side effects of other treatments and often at lower cost, and according to the best evidence it is successful in 88-90.5% of cases.
The reason it's not and likely never going to be available in OHIP is an issue of the "business of medicine" rather than what is right or best for the patient.

Speaking of the Business of Medicine - All is NOT Well with Medical Error Numbers

In the US, purely due to medical error, according to a recent press release by The American Association for Justice. It details how 440,000 patients are killed every year by preventable medical errors. That's in the US, but do you think Canada is much different in its approach to medical treatment?

What can we do?
It is becoming increasingly evident that we must take more responsibility for our own health and adopt less of an unquestioning, blind acceptance mentality when talking to our medical professionals.
We can ask questions about medications and medical procedures and do background research online; we can also look at alternative care options that are often 'marginalized' by medical professionals as being 'unproven' when, in fact, they are just as effective AND less risky than many of the established procedures.

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