During the past several weeks there has been much in the news about contaminated steroid compounds being used by pain management clinics around the country for steroid injection procedures. The result has been a significant number serious spinal meningitis cases, including some fatalities, in patients who received these injections. These tainted compounds have all been traced to a single company, the New England Compounding Center, located in Massachusetts. According to the CDC (Center for Disease Control) none of these compounds were shipped to Washington State. Nonetheless, this has raised questions of steroid injection safety among many patients who have received them as part of their pain management regime.
Steroid injections for the reduction of pain in specific areas have been used safely for decades by pain management specialists. They have been shown to be a viable and effective treatment option for a large number of patients who could not find adequate pain relief through other less invasive treatment methods. The issue surrounding the current crisis is not one of steroid injection safety or efficacy so much as it is one of inadequate oversight of these relatively unregulated compounding pharmacies which are regulated by each State’s pharmacy boards, not by the FDA. The provisions allowing for compounding pharmacies, which provide individually tailored formulations of drugs, were meant to fulfill a specific need for patients who needed specially compounded formulations of medications not manufactured by larger pharmaceutical companies. While the FDA has strict standards that the larger established manufacturers must adhere to, the smaller compounding pharmacies do not fall completely under this safety umbrella. Most patients and even some physicians have been unaware of this. There is already a serious investigation underway of the conditions that allowed this to occur and I am quite certain that regulatory changes to minimize the chances that this can happen again will be implemented.
In the meantime what are we to do? In our pain management practice patient well-being and safety is paramount. We procure our drugs and supplies from only the best and most reputable companies in the pharmaceutical industry, and have never bought them from compounding pharmacies. It is likely that your provider has the same concerns and safeguards in place. If you have any question regarding the medications you receive you have the right to ask your provider about the source and safety of those medications. Additionally, the manner in which the procedures are performed is important. These procedures are optimally performed with the use of fluoroscopic or ultrasound imaging guidance to minimize the risk that the needle might be incorrectly positioned. Incorrect placement could potentially cause injury, or, at the very least, provide inadequate relief. We perform our procedures with the use of fluoroscopy to insure the precise delivery of medication to the target areas. Other imaging methods such as ultrasound can be effective as well. When consulting with your provider be sure to ask about this.
Effective management of your chronic pain, whether through medications or interventional procedures, has the goal of both trying to reduce pain and increase function. Be certain that you seek the guidance of a qualified specialist to receive the safest and most effective treatments. In recent years our understanding of the sources of chronic pain as well as our abilities to diagnosis and treat chronic pain conditions has improved substantially. Your primary care provider should be able to refer you to a qualified pain specialist in your area.