Epidural Steroid Injections Defended

Epidural Steroid Injections Defended

A National Pain Report story on a study that questioned the efficacy of epidural steroid injections (ESI) for back pain relief has drawn a strong response from a prominent Kentucky pain specialist.

Dr. James Patrick Murphy, who is Medical Director of the Murphy Pain Center in Louisville, Kentucky, is an anesthesiologist and is certified in pain medicine.  He is also an Assistant Clinical Professor at the University of Louisville School of Medicine.

We asked Dr. Murphy to share his thoughts.

“Of the over 100 million Americans living with chronic pain, low back pain is the most common ailment. While low back pain can result from numerous causes (e.g., muscle spasm, ligament strain, fractures) many cases of low back pain ultimately involve inflammation of a spinal nerve. When a spinal nerve is inflamed, as is commonly the case when a disk herniates, the pain usually extends from the back to the leg, and sometimes all the way to the toes. Depending on the severity of the disk herniation and inflammation, the leg can go weak or go numb or both. This miserable situation is called radiculitis.”

“Epidural steroid injections place powerful anti-inflammatory agents very close to the source of the pain. The goal of the epidural is to diminish inflammation, improve function, and promote healing. As a pain specialist, I have personally witnessed the tremendous benefit these epidurals offer patients. I have also witnessed the unfortunate ones for whom this procedure does not help. One of the themes to my “informed consent” spiel is that an epidural will not be a cure. Your body actually has to cure itself by repairing the herniated disk and turning off your internal inflammation switch.  The epidural’s role is to jump-start the process and keep you functioning and less painful during this time of healing”

“Metaphorically speaking, epidurals might be to the pain specialist what the nine-iron club is to the golfer -an important tool for certain situations, not be used in every situation, and best used in conjunction with other tools as part of an overall “game plan.” The most important factor is deciding whether or not, for you, the epidural’s benefits outweigh the risks.  A patient considering an epidural needs to discuss these risks along with the potential benefits and available treatment alternatives with the clinician. Epidurals are not appropriate for every patient with low back pain, but in properly selected patients the evidence, along with my personal experience, is that epidurals can be very effective in allowing a person suffering from spinal inflammation to function and participate in programs that promote healing.”

Dr. Murphy also cited a paper by Dr. Steven Cohen that is, what Dr. Murphy calls, a comprehensive review of the data and expert opinions: Epidural Steroids A Comprehensive, Evidence-Based Review, by Steven P. Cohen, MD, et al. To read it, click here.

One of his patients has submitted a “My Story” talking about her experiences with ESIs which we will publish at a future date.

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Authored by: Ed Coghlan

There are 6 comments for this article
  1. Gary Snook at 10:12 am

    Epidural steroids have been used off label for over 30 years off label as there is no steroid approved for use epidurally by the FDA. Many countries have BLACK BOXED most of the ones routinely used in the U.S. by doctors who almost never mention the extreme risks that have been associated with this procedure. Well…………..How do you think we are doing?
    We have had an explosion of injections and it has mushroomed into a 90 billion dollar industry.
    Are we enjoying better health? More pain free hours?
    The current health care crisis of 100,000,000 American’s who suffer back pain is because we have these procedures. They do not work! As a recent Department of Health and Human Services study pointed out. The benefit the patient experiences is so small that mathematically it cannot be measured.It is long past time for something new and Doctors who are preforming these injections need to stop. They need to find something that actually works and quit poking holes into the most pristine and sensitive organ in the human body. Yes stop these worthless and barbaric procedures that are disabling patients at an alarming rate.

  2. Stephen S. Rodrigues, MD at 7:08 am

    @Stephen M

    YES – I’m an eyewitness!

    This “dealer or pusher” mentality of some pain medicine providers is common. “They know not what they do.”

    Patients have been disrespected, demoralized and stripped of their dignity by this catch 22 for a long time, all because of someone changed a natural law.

    The truth is Long-term pain has been and will always come from the muscles. This means that all pain can possibly be treated and removed with massage, stretching, joint range of motion exercises, traction, inversion, chiropractic adjustments, thin or hypodermic and needling.

    The break in reality or the broken natural law is long-term pain is in the skeletal components, in nerves roots, nerves or the brain.

    If man breaks a natural law, he will pay a huge fiscal, physical, emotional cost or perish.

  3. Stephen M at 4:45 pm

    Has anyone else been denied treatment by Pain Management for refusing or even politely & respectfully questioning epidural steroid injections?

    I know that they help some people, but the rest of us are backed into a corner with Pain treatment and aren’t in a position where we can make informed choices about our own care.

    Does anyone have any suggestions?

  4. Stephen S. Rodrigues, MD at 8:08 am

    I have been practicing medicine for 30 years in various settings such as high volume clinics, group and solo practices using conventional medicine. In the past 18 years after adding into my daily practice many alternative and complementary remedies, I now have a better sense of what works.

    What is even more important is I am 100% certain of what does not work.
    How can I be 100% certain?
    You must obey ALL the natural law set forth by the universe, if not you will suffer or perish. A theory, therapy, remedy or treatment can not work if it breaks any universal laws of nature. If a treatment is not grounded in reality, short cuts the biology and science it will fail and leave lasting misery.

    The betrayal of science:
    A few intellectuals change the way we all think about the correct location of pain. In doing so they moved our thinking from the natural location to an unnatural location. The natural location of everyday aches, pains and stiffness has been and always will be in the muscle system. These intellectuals conceptually moved the location to the unnatural location of the skeletal system.

    This lapse in judgment did not simply change a point of view, it actually broke a universal law of nature, biology and the human body. This poor judgement has led people to believe that all pain has form, structure and can be seen by X-ray or MRI. Subsequently many people believe that their pain can be removed like a tumor.

    This change in the true location and thought of pain is directly contributing to a massive number of poor clinical outcomes, opiate overuse and abuses, overdoses, suicides, drug abuses, failures of surgical pain cases, waste, fraud and abuses.

    The FALSE:
    The skeleton is the best and the exact cause of everyday aches, pains and stiffnesses.
    “We can see your pain on this MRI.”
    “We can remove your pain by removing the defect we see on the MRI.”
    You pain is “arthritis” so you need to do is take these anti inflammatory medications.
    Physical Therapy will not help arthritis, eventually you will have to get the joint replaced anyway.
    Don’t worry about muscles they are innocent and can not contribute to your “bone and joint” pains.
    Complementary and Alternative Medicine options can not treat the bone so take these pills for now and mentally get yourself ready to get surgery.

    Falses that was turned into a True:
    Key fallacies which are accepted as “OK, wink wink” despite the evidence to the contrary.
    The amputation and replacement of human joints for the treatment of pain.
    Injecting caustic chemicals into the spinal canal in the quest to remove pain.
    Rearranging tendons and ligaments in the quest to remove pain.
    Assuming the patient is ignorant, unreliable and untrustworthy.
    If your pain does not go away after we fix the bits and pieces on the MRI, it is your fault.
    You are sent to psychiatry to look into your personality.
    You are sent to a neurologist to look into your brain and nerves.
    You are sent to a rheumatologist to look into your blood.
    You are labeled a combative, stubborn, obnoxious or drug seeking person.

    The TRUE:
    Everyday aches, pains and stiffness has been and always will be in the muscle system. The muscle system is the only organ system that can store and radiate pain. Muscle pain is invisible pain, very personal pain and can only be discovered, confirmed and removed with human touch. The pain this is in muscles is 100% treatable!!!

    There are only 4 ways to assist in the natural healing of the pain within muscles. 1) You must engage in a self care program; wellness, sleep, yoga, range of motion exercises, traction, inversion, diet, stress management. 2) Outside the skin; manual labor into muscles and connective tissues stimulation. ie Massage, spinal adjustments, formal traction, formalized range of motion exercises and active tissue release. 3) Inside the muscle; thin wire needle stimulation as per GunnIMS. 4) Inside the muscle; hypodermic needle stimulation as per Travell, Hackett or Rachlin injections.

  5. Kim Miller at 10:14 pm

    I do not wish to have epidural injections because I am terrified of them. I have been a patient of Dr. Murphy’s for several years now and I have NEVER been approached about having epidurals. I personally know patients from different provider’s offices who were told, “There’s nothing else we can do for you”, upon refusing to continue with epidural injections. This has not been the case at Dr.Murphy’s office.

    If I were to ever need this type of treatment, James P. Murphy, M.D., is likely the only provider I would personally trust to perform them. I have had a series of somewhat dangerous injections at his practice that I asked to have. I had severe, chronic Costochondritis, for which Dr. Murphy performed a total of seven intercostal nerve blocks. These are only dangerous due to their proximity to the lungs and the slight possibility, therefore, the needle could puncture the lung.

    These injections have made the pain I was having diminish greatly. It was an all day, every day pain and I cannot fully express the relief these injections provided.

    I do not believe patients should have epidural injections held over their heads as a form of extortion. ” Either get the expensive, but dangerous procedure, or no more pain medication “. But this is not the practice at the highly respected office of Dr. Murphy.

  6. Thomas Bresnahan at 1:34 pm

    With due respect to the doctors opinion when it comes to the effacicy of ESI’s I would have to ask a few questions and or comments. If these injections work so well why has the maker of Depo Medrol, Pfizer, had Black Box warnings placed on their drug in other countries directing that it NOT be used “in or around the spine”? Why do they warn of “Arachnoiditis and other Adverse events” if used for epidurals? Why would any caring, ethical physician risk their patients long term health and well being on a procedure that at “Best” is a Band Aid that might give a patient a few months relief, at worst a life of pure living Hell! I’m permanently disabled because a Surgeon pushed a needle a centimeter too far and injected Depo Medrol into my spinal cord! I had an MRI done yesterday because my pain and leg function is deteriorating. The nerves in my spinal cord are now one solid mass. I will most likely end up in a wheel chair! Why? Because of a Band Aid! Because a doctors arrogance and wallet was more important than my life!