We’re winning the war on opioids, according to a study by Avalere, which showed that the number of opioid prescriptions sold in the US declined 11% in 2017. The decline was steeper in states where legislation limiting prescriptions has been enacted. Unfortunately, people are still experiencing chronic pain and need something to treat it. In line with the concept of unintended consequences, experts have sounded the alarm over one approach that some pain intervention specialists are taking.
Anti-Inflammatory Spinal Injections
The controversial treatment involves injecting anti-inflammatory drugs close to the spine to treat back and neck pain (New York Times). The article reported that Pfizer, which markets Depo-Medrol®, one of the injectables being used, has stated that the drug is not intended to be injected near the spine and that some providers are using the drug in an off-label manner. Pfizer went so far as to petition the Food and Drug Administration (FDA) to ban the drug’s use for spinal injections back in 2013.
The pharmaceutical giant cited the risk of blindness, stroke, paralysis, and death after receiving hundreds of complaints from consumers. The petition stated that Depo-Medrol “must not be used to the intrathecal, epidural, intravenous, or other unspecified routes.”
The FDA denied Pfizer’s request, but agreed to include a more forceful warning on the label and issued a safety alert, which resulted in a decline in use. Other countries, like Canada, Australia, and France banned the use of the drug.
|“A review of FDA records shows that there were 2,442 serious problems reported from Depo-Medrol injections from 2004 through March 2018, including reports of 154 deaths.”
Source: New York Times
Use of Injections are on the Rise
The Times article stated that the practice is now on the rise as an alternative to opioid treatment.
- The number Medicare providers administering spinal steroid injections increased 13% between 2012-2016.
- The number of Medicare beneficiaries receiving spinal steroid injections increased 7.5%.
- The Department of Veteran’s Affairs saw a 17% increase in spinal steroid injections between 2015-2017.
According to the IQVIA Institute for Human Data Science, the utilization of brand name and generic Depo-Medrol increased 35% between 2015-2017.
Are Injectables for Back and Neck Pain Effective?
- Back and neck pain, which cost the US $88 billion dollars a year in 2013, contribute to disability and workers’ compensation costs (Institute of Health Metrics and Evaluation). The cost to treat both conditions more than doubled between 1996-2013. The Institute asserted that most treatments don’t work.
- A 2015 review published in the Annals of Internal Medicine looked at 30 placebo-controlled studies of epidural steroid injections for back pain that radiates to the leg, and 8 studies of neck pain caused by narrowing of the spinal canal. The review found that the injections provided some short-term pain relief, but were no more helpful than placebo in the long-run.
- Anecdotal evidence in the Times article reported that:
- 2 women from different states said they were told by pain clinic doctors that “they would only prescribe pain killers if agreed to an epidural steroid injection.” Both reported that the injections didn’t work.
- A former photojournalist stated that the injections, “inflamed his nerves, leaving him bedridden for nearly 3 years.” He still suffers central nervous system disorders.
What Can Employers Do?
You can use your employee data to identify how this may impact your population. My colleague, Debbie Partsch, Pharm D wrote an excellent white paper that explains how.