Drug Maker Warns that it’s Steroid used for Epidural Low Back Injections shouldn’t be Used that Way

By Chris Centeno, MD /

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steroid back injection side effects

Is there even more on steroid back injection side effects than has made the news? Although Bristol-Myers changed the label on its Kenalog steroid seven months ago to say that it’s “not recommended” for injection into the epidural space near the spine, the steroid is still being used that way, according to a Bloomberg report. You’ve likely heard of the tragic meningitis deaths tied to a compounded steroid made by NECC. This issue with Kenalog is a different issue altogether, which is due to the continued use of “particulate” steroids in and around the spine. Particulate steroids are oil in water type emulsions that look milky and are generally made by large drug manufacturers. These small particles of steroid can potentially block the tiny arteries that supply the spinal cord if these arteries are inadvertently entered during an epidural injection. An epidural is a common injection route for patients with chronic back or neck pain from a bulging or herniated disc. What can happen and why did Brstol-Meyers change the warning on the packaging of Kenalog? If these arteries get blocked, a few cases of paralysis and even death have been reported. This very rare problem first surfaced around 10 years ago and everyone we know has long since moved away from using particulate steroid in favor of steroid that has no particles that can block little arteries. However, with this press release warning, the company made clear that there are still lots of doctors using particulate steroids. Because of this and other significant risks of using these ultra-high dose steroids such as increasing the risk for avascular necrosis and damaging local tissue, we have tried to move as many patients away from even non-particulate steroids (the kind that don’t block arteries). Instead of using these potentially tissue damaging medications, we can help disc bulge patients just as much or more by using the growth factors from their own blood platelets, a much more natural and in our minds, safer alternative. The upshot? Even if your doctor didn’t get a contaminated vial of steroids from NECC, make sure you ask if they still use particulate steroids in the epidural injection. You can tell because the steroid will be a milky color rather than clear. In addition, you may want to make the switch to a more natural way to manage back and neck pain.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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