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Friday 26 October 2012

Epidural Steroid Injection Risk: Incurable Arachnoiditis - ABC News

Epidural Steroid Injection Risk: Incurable Arachnoiditis - ABC News
more from the above link, xx soft hugs xx



Helen Bertelli, a mother of two young girls from Raleigh, N.C., has been crippled with weird symptoms -- electric shocks, muscle cramps and the sensation that water is running down her legs -- all since she received an epidural steroid injection for back pain in 2011.
Three months after a medical "fellow" administered the shot at a pain clinic, she had trouble urinating, then both her feet went numb.
"I had this feeling I was connected to the end of a guitar string and someone was plucking it," said Bertelli, 36, and a former runner and hiker. "My legs just exploded like there were fireworks in them. My muscles twitched like they were boiling."
For months doctors told her the knife-like pains were in her head, but six months later, Bertelli was diagnosed with arachnoiditis, an incurable condition that can be associated with epidural steroid injections.
Today, she tells ABCNews.com, "I feel I have been dropped into a nightmare with no hope of waking up."
Arachnoiditis is not fungal meningitis. The outbreak that killed 23 and infected 308 patients nationwide was linked to contaminated steroid solution prepared by a Massachusetts compounding pharmacy.
What Bertelli has is a pain disorder caused by the inflammation of the arachnoid, a delicate spider web-like membrane that surrounds and protects the spinal nerves, spinal cord and brain. The three most common causes are surgery, infection and chemical irritation.
Meningitis Outbreak: 7 People Confirmed Dead, 60 Others Being Treated Watch Video
Meningitis Outbreak: 5 Dead Watch Video
35 Meningitis Cases Blamed on Contaminated Steroid InjectionsWatch Video
"It's rare," said Dr. Ray M. Baker, an anesthesiologist and president of the International Spine Intervention Society.
But advocates, including Baker, say that the rising number of epidural steroid injections -- many performed by untrained clinicians -- signals the need for better medical and patient education about risks.
There is some evidence linking the preservatives in steroid medication to arachnoiditis, when the medication is accidentally injected into the spinal fluid. Fluoroscopic (x-ray) guidance is useful with spinal injections, as it confirms needle placement outside of the spinal fluid and allows for safe injection, according to Baker.
"With the right hands, the right skill set and the right patient and the right conditions, they are safe and quite effective," said Baker. "We don't have a lot of policing or oversight to say what are the standards and the rules."
And consumers don't know what a "quality job" is, he said.
"Although the fungal meningitis outbreak is a horrible tragedy, we need to be looking at lessons learned," he told ABCNews.com.
"If any good can come from this, in addition to shining a light on the need for greater oversight of compounding pharmacies, it might be that the media attention on steroid injections will allow patients to become better-informed consumers. For patients, it is buyer beware."
An estimated 5 million epidural steroid injections were performed in the United States in 2011, based on data from Medicare, which pays for about half of all such procedures.
"If I were a patient, I would start asking questions," said Baker. "As with other things in life, skill, training and experience matter. ...For the sake of patient safety, and to maintain public trust, spinal interventions should not be the domain of anyone and everyone."
A patient group, led by Bertelli, has urged the Food and Drug Administration (FDA) to provide more comprehensive training of the practice, better oversight of physicians and better patient consent forms that include arachnoiditis as a potential complication.
She also wants better tracking of adverse events and better guidelines for doctors on contraindications.