Meningitis Outbreak Raises More Questions about Spinal Injections

An organization of chronic pain patients warned the Food and Drug Administration about the dangers associated with epidural steroid injections months before a fatal outbreak associated with the procedure.

Thirty five people in six states have contracted a rare form of fungal meningitis linked to an injectable steroid. Five of those patients have died, according to the Centers for Disease Control and Prevention.

Health officials believe the meningitis was spread by a contaminated steroid that was injected into the patients’ spines for back pain. Investigators are also looking into the antiseptics and anesthetics used during the injections.

In a June 8 letter to the FDA, Helen Bertelli said epidural steroid injections (ESIs) were responsible for thousands of cases of arachnoiditis, a chronic and painful neuropathic disease caused by inflammation of the arachnoid membrane, which surrounds and protects the spinal cord.

Bertelli developed arachnoiditis after receiving an epidural steroid injection in 2011 for a bulging lumbar disc.

“The procedure was excruciatingly painful, and within a week I was experiencing strange new symptoms,” Bertelli wrote to FDA commissioner Margaret Hamburg.

“I now endure pain and symptoms every day, including severe stabbing pains and electric shocks, muscle cramps and fasciculations, strange sensations akin to water running down my legs or insects crawling and biting me, extreme fatigue, etc. The toll that this has taken on my family emotionally, financially and physically, is terrible,” said Bertelli, a member of Advocacy for Victims of Arachnoiditis.

The group is calling on the FDA to improve training and oversight of physicians who perform ESIs, and to warn patients about potential side-effects of spinal injections.

“Lives have been ruined by a procedure that has, at best, an equivocal track record in medical studies. Yet the procedure’s chequered history does not seem to deter doctors, some of whom have alarmingly limited training in the administration of ESIs, from performing it on patients millions of times each year,” Bertelli said.

The growing use of ESIs to relieve back pain is due, at least in part, to federal and state crackdowns on narcotic pain relievers, according to Walt Davis, the chairman of Advocacy for Victims of Arachnoiditis. Davis says pain clinics or “injection mills” are popping up in states where painkillers are becoming hard to get.

“A lot of clinics that we know about, before they will prescribe any form of pain medication for your condition, regardless of what it is, require you to go through a series of epidural steroid injections. And in a sense some pain patients are being held hostage to undergo those invasive procedures,” Davis told the National Pain Report. “I think the crackdown on the prescription pain medicines is only going to exacerbate this problem. We fear that if these crackdowns continue to get worse, we will see a huge increase in our numbers – patients with arachnoiditis.”

The steroid associated with the meningitis outbreak — methylprednisolone acetate — was recalled last week by New England Compounding Center, a specialty pharmacy in Framingham, Massachusetts. Many of the meningitis cases were linked to three pain clinics in Tennessee, where hundreds of patients received the steroid in the last few months.

Meningitis is caused by the inflammation of meninges, which are protective membranes that cover the brain and spinal cord.

Authored by: Pat Anson, Editor

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Justin Lewis

This is a VERY serious matter that NEEDS serious attention or good, honest, clean, hard working young people may die! I went to Georgia Pain Physicians in Calhoun, at my primary physicians recommendation, for some relief of my multiple health issues and severe pain from accidents at work and automobile wrecks that were NOT my fault, but instead was BLACKMAILED! They put me on a small amount of weak pain medications for a couple of months, which did help a little, then gave me two sets of two steroid injections in my back, which just made things WAY worse. After I told the doctor these facts, he then told me on my last visit, right before I PERMANENTLY dismissed MYSELF from their lousy services, that if I did not agree to a third set of their highly profitable IN OFFICE injections, that he could not be of any more service to me, and I could not have any more of the helpful prescription pain medications I was on. The doctor even ADMITTED that they did those EXTREMELY painful injections before even getting my records, x-rays, or MRI reports from my primary doctor. They NEVER even recommended any kind physical therapy or a spine specialist either. The ONLY thing they did is a load of IN OFFICE procedures that made THEM thousands of dollars at the expense of GA Medicaid!. I potentially lost thousands in income, and worse yet, have likely lost years of my life. NOW, I am STILL sitting here in severe pain, dying of congestive heart failure due to not being able to get any kind of exercise because of this malpractice, my knees and hips are cracking and popping from injuries and I am barely able to walk AT ALL, and I have severe arthritis in my neck from being rear-ended by a crack-head traveling at 70MPH while I was sitting still in my car, with absolutely NO relief in sight. I have been an outstanding member of my community my entire life, volunteering and helping everybody I can for next to nothing, and all while staying clean of illegal drugs and going to school, till everybody else decided that they DID NOT have to abide by the rules, do their damn jobs, and be good people! These QUACK MEDICAL LOW-LIVES are committing FELONY EXTORTION and I am going to have them closed down and charged with these crimes if they are not willing to do the right thing, and actually help people! I just need some REAL physical help here! Is that too much to ask from people! I need help with this. I have a brain injury as well from that life altering car accident I was in on April 15, 2000′. I haven’t even been able to have sex since I was 20 yrs.old for ACTUALLY crying out loud in pain ALL of the time because doctors like this on won’t help! I’m starting to just HATE doctors in general.

Sheila Kalkbrenner

Epidural Steroid Injections are not the only PREVENTABLE cause of arachnoiditis.
I have spinal adhesive arachnoiditis caused by a single injection of spinal anesthesia with 5%lidocaine. I received this injection in 2007, long after the label had been changed to warn physicians not to use it for this purpose (1995). I was not advised of the contents, warned of the risks, or informed of this off-label use. I have no history of any other back injury or neurological disorder. I was given spinal anesthesia for a routine right knee arthroscopy procedure.
Patients who have received epidurals during labor and delivery have also developed arachnoiditis as a result of spinal anesthesia. Learn more at

In my opinion, all the noise the government is making about opioid pain medications, is not true. These shots are much more invasive than taking medication with a patient that is finding relief from. If a drunk/addict wants to kill themselves then let them. They will achieve it with or with prescription medicines. They will take anything they can find on the streets. On the otherhand, the government, DEA, FDA, they want to get the opioid pain medicine out of the pain patients reach and just give injections and in most cases give very little, temporary or no pain relief with a huge chance of harming them. The doctors are milking our insurance companies and causing the premuims to increase for everyone and these ESI’s are a huge cause. These are preformed several times daily while the doctor is raking in the cash. Which makes most sense? Medication if it’s working or these ESI’s? I believe that the accusations against pain relievers has been over blown. The stats are not bad enough to remove medicine from our reach. 15 thousand people dying nation wide in 2009 in a growing population is not high enough to say they are killing too many people. Closing pill mills that hand the medicine to patients at the doctor office, yes they should be closed but any doctor that is educated in pain management should be allowed to prescribe what ever dosage the patient needs, as long as they fill at the pharmacy so the database can record it. I am finding that doses are being severely cut and these injections are on the rise. I say, we all start screaming for our rights to the least invasive measure needed for any illness, pain included. Stop the triple digit incomes from needless surgeries and ESI’s. They do no good and cause usually more pain. Unless paralyisis or great harm is going happen than no need. Being railroaded by a shot jockey that holds a small prescription of pain medicine in one hand and the needle in the other giving ultimatums, to get one you must get the other is plain wrong. It’s blackmail and I feel that injections should be outlawed. I have heard from many people that more harm than good is achieved by these injections. The last time I had one? I carried a daily fever for over 3 months, headaches and severe body aches. Now what was that? My imagination? No.. it was results of these injections. Intractable chronic pain is not just a skeletal spine ailment it can be from many different causes but most PM doctors want to give them away.
Come help us fight for our rights to pain care the least invasive way at, “Fight For Pain Care Action Network”.

Doc ForthePeople

Doctors who do these injections are also paid exceedingly well and at least in some parts of the country do not do any management of the patient suffering either unrelieved pain, or worsened pain. The patient who fails to respond to the injections are often turned back to the primary care doctor. the primary care doc or the medically managing doctor is faced with huge overhead in terms of monitoring the patient whose only recourse is chronic medication and the reimbursement is at the lowest end of the spectrum. Meanwhile the injectionist who does procedures only and no long term disease management takes his/her high pay and moves on to the next victim. The aspergillosis meningitis epidemic is just a huge example of the harm that is being done to the victims of the injections. While arachnoiditis is not as lethal as aspergillosis it does destroy what limited normal life the pain sufferer had left. The duration of suffering exceeds all but a handful of other disease such as CRPS (Chronic Regional Pain Syndrom)

Treatment of chronic pain sufferers has been herded into these injections of questionable benefit by both regulatory and busisness and reimbursement issues. PPerhaps the diversion of sientific inquiry AWAY from the true underlying nature of chronic pain is as despicable as the mistreatment of the patients.

It is a sad lesson, and by the way, the death rate from aspergillosis among pain sufferers is essentially the same as that seen in West Nile Virus in the general public. The difference is that these injections are aimed ONLY at a specific group of people disabled by their chronic pain. And the transmission vector for West Nile Virus is a mosquito. The transmission vector for aspergillosis meningitis for chronic pain sufferers is a “doctor”.

Let us all pray for the existing and impending victims and their families! God know, the shot mills have their money and clearly do not know what to do now. Based on their track record they probably do not care either.

Rebecca Roberts

I am so glad to see that Arachnoiditis is in the news. I contracted this disease thru an ESI’s in 2005, my dura was punctured and it has been a very hard time in my life. This disease is just terrible, intractable chronic pain 24/7. I had to quit my job because of the pain being so great. I now have to live on SSDI, , and very limited at what I can do daily. This is good news for all of us that suffer from Arachnoiditis..