Monday, August 20, 2018

After Doctors Cut Their Opioids, Patients Turn to a Risky Treatment for Back Pain

An injectable drug that the manufacturer says is too dangerous to use along the spine is growing in popularity for back pain as doctors turn away from opioids.

The anti-inflammatory drug, called Depo-Medrol and made by Pfizer, is approved for the injection into muscles and joints. Once a drug is approved, however, doctors may legally prescribe it however they see fit.

What few doctors or patients know is that Pfizer, faced with hundreds of complaints about injuries and complications related to the shots, asked the Food and Drug Administration to ban that type of treatment five years ago. The company cited the risk of blindness, stroke, paralysis and death – a request that neither the agency nor Pfizer made public.

The FDA declined to issue a ban but toughened the label warning. Other countries – among them Australia, Brazil, Canada, France, Italy, New Zealand and Switzerland – heeded Pfizer’s request.

After concerns were raised about the off-label treatments, use of the injections declined. But the opioid epidemic appears to be spurring their popularity despite risks known to public health officials and doctors.

According the FDA, back problems are the most common cause of disabling, chronic pain. Weekend classes to train physicians in the procedure are flourishing. Critics like Dr. Terri A. Lewis, a rehabilitation specialist and lecturer at the Southern Illinois University, say they are responsible for transforming pain clinics into “drill mills.”

And in June, as part of legislation to tackle the opioid crisis, the House of Representatives approved an increase in Medicare reimbursement for the procedure.

“The truth underlying it is that doing an injection is faster and results in higher reimbursements, compared to other ways of managing the same pain,” said Dr. James P Rathmell, chairman of anesthesiology, perioperative and pain medicine at Brigham and Women’s Hospital. It was Dr. Rathmell who first brought the issue to the FDA and oversaw a panel charged with recommending guidelines on safety. “The use of injections has increased dramatically, yet the prevalence of back pain has remained relatively unchanged,” Dr. Rathmell said.

My Take:
As a chiropractor, chronic back pain does offer some challenges. But in the absence of permanent nerve damage, it is simply a matter of reducing inflammation, correcting injury reflexes, careful spinal manipulation and gait retraining.

These paraspinal injections only address inflammation and do so by blocking the process with steroids. While this may provide some temporary relief, without addressing the other factors, the pain will return.

Bottom Line:

Please try conservative chiropractic care with a physician that combines manipulation with nutritional support for inflammation and neurological reprograming.

Epidural steroids should be reserved as a last step prior to spinal surgery. And spinal surgery should never be performed to reduce pain but rather to restore neurological function.

Source: July 31, 2018 The New York Times

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