New recommendations aim to improve the safety of steroid injections to ease the pain of the spine

More and more people are seeking anti-inflammatory steroid injections for pain and neck. In 2011, the last year for which complete information is available, doctors pushed the piston 2.3 million steroid injections in the spine - and that is just one of the people covered by Medicare.

These injections deliver drugs that mimic the effects of two hormones, cortisone and hydrocortisone to reduce inflammation and relieve pain. When work - not always - these injections can bring profound relief.

"If you are in severe pain with a broken spinal steroid injection and a disk is obtained, you will feel better before," says Dr. James P. Rathmell, professor of anesthesia at Harvard Medical School. "This is good part. " 

But there is a bad part, too. Steroid injections in the spine can cause partial or total paralysis, brain damage, stroke and even death. This week, in a Watchtower article in the Journal of the Medical Association Dr. Rathmell US and two colleagues Spotlight their new safety recommendations to help prevent these rare but real problems.

"There are these very, very low risk of some serious side effects that we believe we can prevent," says Dr. Rathmell. "If you do these injections in the safest way, I think the risk is very low."It is difficult to accurately spinal injections often go wrong. Dr. Rathmell and other reports collected many cases as possible, but the exact numbers and rates are unknown. "My belief, based on small numbers that are out there, is that it is probably less than one in ten thousand," he said.

So there is no need to flee for fear of steroid injections in the spine. But it is important to be aware of the risks and know what your doctor can do to minimize them. The same is true for anyone considering steroid injections for joint plagued by arthritis, a torn rotator cuff, sick ankles, and more.

The narrow margin 

The spine is a hot spot for potential damage because the margin for error is very small. "You are right next to the spinal cord and neck which is near the brain," says Dr. Rathmell. "That's what makes it so important to do accurately."

However, the risk of steroid injections in painful joints are usually less severe. As I explain in the December 2014 Harvard Health Watch for men, the main safety concern when steroids are injected into joints is infection - something that is always possible when a needle sticks in the body.

Another general concern is the frequency of steroid injections. Steroids are powerful anti-inflammatory drugs. Repeatedly put in cloth fabric and soft cartilage can break down and cause these to shrink. Steroids can also suppress the immune system.

The general recommendation is to limit the number of injections three or four per year per treated site. In some cases - as with painful rheumatoid arthritis - this limit can be exceeded.

Road safety for spinal injections 

In 2002, Dr. Rathmell and a handful of colleagues began to note reports of serious injury steroid injections in the spine. The worst cases include partial or complete paralysis, stroke and death. In 2014, the FDA began requiring a warning on labels of injectable steroids.

These case reports prompted more than a decade of study and discussion among a group of 22 anesthesiologists and other specialists, led by Dr. Rathmell. This month, their work has resulted in a series of recommendations to steroid injections in the spine through on safe FDA Safety Initiative. The group also published a comprehensive report on the recommendations in the number of the month of the journal Anesthesiology.

The recommendations are detailed and technical. They cover medications and techniques to use in different situations to reduce the risks of steroid injection in the spine. This clinic crib sheet was approved by 13 specialized medical societies.

Following the recommendations is completely voluntary, and there are no studies showing that actually prevent injuries. But to establish a baseline. "You are the best experts to say" Here are some things you can do to make it safer, "said Dr. Rathmell.

Be informed and curious 

Dr. Rathmell encourages patients to be informed and curious about the potentially harmful procedures. "It's like any medicine. Express your fears. Tell me what's really worried about what I can assure you. Good push even more patients."

The risk that something goes wrong after an injection of steroids marrow are low. But these negative results are potentially catastrophic, so it is a legitimate question to raise anyone planning an injection of steroids into the spine.

"I think it's great when someone comes and asks me if he can be paralyzed by this injection," he said. "This is the right question to ask. The answer is yes, but the chances are extremely low. Can I describe exactly what I'm going to make it as low as humanly possible."