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Should you avoid all steroid injections for your back pain?

Consumer Reports News: October 15, 2012 10:08 AM

The news about fungal meningitis from steroid injections has many back pain sufferers wondering if they should now avoid the shots entirely. Our medical experts say no: The deaths and health problems currently being reported are associated with three batches of the drug made by a single pharmacy. And steroid injections sometimes do seem to help relieve debilitating back pain. But our experts also caution that the injections should be used only for specific kinds of back pain, and even then only if a number of simpler methods have been tried first and failed, and if a number of precautions are carefully followed.

The Centers for Disease Control and Prevention says that as of Monday morning 200 people in 14 states have been found to be infected with fungal meningitis, and 15 have died from it. All of them were linked to a steroid product made by New England Compounding Center in Framingham, Mass. The CDC has an online map that shows the states affected and lists the clinics that received the contaminated product. The CDC also has advice on what people should do who think they might have been given one of the injections.

Our medical experts say that the injections pose other concerns, too, and offer limited benefits. "The vast majority of people with lower back pain don't need the shots," says Orly Avitzur, M.D., Consumer Reports medical adviser and neurologist. Their benefits seem limited mainly to people with lower-back pain that also travels down the buttock or leg, according to guidelines from the American Pain Society, the American Society of Interventional Pain Physicians, and the American Academy of Neurology.

And our analysis of the shots last year found that even in those cases the shots typically provide only short-term relief, and don't do much to reduce the need for surgery or provide pain relief beyond three months. But they can help people through a particularly painful stretch, which might allow them to, for example, start an exercise program, or use them as a last-ditch effort to avoid surgery.

In addition, the shots can cause a number of side effects, ranging from minor and short-lived ones such as headaches and dizziness to rare but potentially deadly ones. Those include not only meningitis but also damage to the spinal cord, nerve injury, and an epidural abscess, which can cause incontinence, urinary retention, fever, and back pain.

For those reasons, our experts say that most people with back pain, including pain that radiates down the leg, should start with simpler measures. Those include over-the-counter drugs like acetaminophen and ibuprofen, hot and cold compresses, physical therapy, exercise, and nontraditional therapies such as acupuncture, massage, and spinal manipulation.

If those measures don't help, shots might. But even then, you should take steps to make them safe. That includes getting medical clearance from your doctor and seeing an experienced practitioner.

For details, see our report Steroid injections for lower-back pain: Worth a shot? and our comprehensive guide to treating back pain.

Joel Keehn


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