NC5 Uncovers New Concerns About Back Pain Shots
By Jennifer Kraus
NASHVILLE, Tenn.- Every year, nearly 8 million patients with chronic back pain get an epidural steroid injection, a shot directly into the spine.
We're hearing more about them now because of the fungal meningitis outbreak.
But NewsChannel 5 Investigates has discovered it's not just tainted drugs that patients need to be worried about. Some are concerned that the procedure itself could be dangerous in untrained hands.
"I thought I was dying," recalled Darlene Bunch.
The Waynesboro woman got an epidural steroid injection after she got little relief from back surgery for a herniated disc. But less than 24 hours after the injection, she was in the emergency room with bacterial meningitis and an air embolism in her brain.
"My very words I repeated over and over again, 'God, please help me. God, please help me. God, please help me,'" she said.
Bunch eventually recovered from both, but was left with a condition called arachnoiditis that has left her in extreme and nearly constant pain.
NewsChannel 5 Investigates asked Bunch, "This is all a direct result of your injection?"
"Absolutely," she answered.
Bunch is now suing the doctor who gave her the injection. She now knows he had no formal training and instead had learned to perform this rather complicated procedure by watching a colleague a few times.
Barry Weathers is Bunch's attorney.
"You don't spend half an hour or half a day with a friend and become proficient to actually treat patients in a safe way with these injections, yet it's happening all over the country," Weathers explained.
And NewsChannel 5 Investigates has found it's leaving patients like Darlene Bunch with serious, often life-changing complications that some experts say could be avoided.
Dr. Laxmaiah Manchikanti is one of those experts.
"Yes, I'm concerned, and the government is concerned -- everyone is concerned," he said.
Dr. Manchikanti has authored dozens of studies on epidural steroid injections and is the head of the American Society of Interventional Pain Physicians. He does more than 1,500 epidural steroid injections or ESIs a year.
He said that it's a very safe and effective procedure -- when done right. But he believes these treatments are being over-used, in part, because they're highly profitable.
"Sixty percent of the time when they (other doctors) say a patient needs an epidural, they don't," Manchikanti said.
But what he's most concerned about is that some doctors administering these injections are not properly trained.
"Training is the most important aspect," he told NewsChannel 5 Investigates.
Manchikanti said doctors should be trained in three standard approaches for giving an ESI -- and how to determine which one is right for a patient.
Doctors also should know to always use contrast dyes and real-time x-rays to avoid puncturing the lining of the spinal cord, he said. Doctors who don't, he added, are more likely to make potentially dangerous mistakes.
"If you put the medication outside, it's not going to work," Manchikanti explained. "Somewhere else, it's not going to work. Rather it can create multiple problems."
In fact, he now wonders whether mistakes in administering the injections contributed to the fungal meningitis outbreak that has already killed dozens of people, something that he's asking the Centers for Disease Control and Prevention (CDC) to investigate.
"And, I was like, 'Whoa, whoa. Stop. Something's not right,'" Darlene Bunch remembered.
When she had her injection, the needle punctured her spinal cord lining.
Court records show the doctor later admitted that he did not use dye and that he only uses one of the three injection techniques. Yet, he maintains that what he did followed the accepted standard of care, something Bunch believes is unacceptable.
"The pain I was having before I had surgery is absolutely nothing compared to pain I live with on a daily basis now," Bunch said.
There are no training requirements for doctors to give these injections. But several patient groups across the country are now calling on the Food and Drug Administration to issue standards.
With millions of people having these shots these days and the potential problems, they believe this procedure needs more government oversight.
So what do you do if your doctor recommends that you have one of these shots?
Make sure your doctor does a physical examination and takes a full medical history.
But, most importantly, ask lots of questions.
Find out about the training he or she has had, if he or she knows all three approaches, which one they plan to do on you, and -- above all -- will they be using the live x-ray or fluoroscopy and contrast dye during your procedure to monitor where exactly the needle is going.