New Evidence that Steroid Injections Fail to Fix Spinal Stenosis

Every year millions of patients are injected with epidural steroids to treat back pain, but now, new research suggests that many of those injections are completely unnecessary. In a study released Wednesday from The New England Journal of Medicine, researchers found that epidural steroid injections failed to produce any measurable benefits compared to lidocaine injections for spinal stenosis.

This isn’t the first study to question the effectiveness of epidural steroid injections for back pain. What makes this research unique is that it is the largest randomized trial conducted yet on the effects of the injections for spinal stenosis. This condition refers to a narrowing of the spine that causes sciatica as well as pain in the back and legs.

The study included 400 patients with spinal stenosis who received injections of either steroids or an anesthetic (lidocaine). After six weeks, both groups showed similar rates of improvements, leading researchers to conclude that steroid injections “offered minimal or no short-term benefit.”

The FDA has not approved these injections for the treatment of back pain, yet doctors routinely perform the procedure in everyday practice. Why? Because some patients report improvements and many insurance companies require patients to get the injections prior to receiving surgery.

One orthopedic surgeon at Rush University Medical Center in Chicago, Dr. Gunnar Andersson told  The New York Times, “It’s sort of become the thing you do. You see this abnormality on the M.R.I. and the patient complains, and immediately you send the patient for an epidural injection.” Dr. Andersson said the latest study will likely cause more physicians and patients to ask, “Should I really do this?’”

In answering that question, patients should consider the risks. Although the injections are generally considered safe, the FDA warned in April that in rare cases the treatment may cause blindness, stroke, paralysis, and even death. In 2012, contaminated steroid injections were linked to an outbreak of fungal meningitis with 751 cases, including 64 deaths. Many of those infected had received the injections for spinal stenosis and back pain.

The treatment also carry additional risks for the elderly: A study of patients over 50 years old found that every new injection of epidural steroids resulted in a 21% increase in a patient’s risk of vertebral fractures.

For seniors who don’t want to take those chances (however rare), chiropractic care can alleviate symptoms of spinal stenosis in many patients, research suggests. In fact, when it comes to disc herniation, one trial found that chiropractic was just as effective as epidural steroid injections in easing back pain, but without the costs or risks.

Written by: Marissa Luck on July 3, 2014.on July 7, 2014.

15 Biggest Reasons For Sleep Deprivation

Many times patient's  will ask for factors that create such poor health in our Society.  My number one response is SLEEP!  In 1900, Americans slept and average of 9 hours a night as compared to 6 hours in 2008.  It is during deep sleep that Adults replace and repair cells.  With sub-par sleep comes cellular deficit and pre-mature aging of the body. In a recent article posted by the Amen Clinics you will find what Dr. Amen deems the 15 most common causes of Sleep Deprivation.  

In our hectic, 24-7 society, we could easily ask “what doesn’t cause sleep deprivation?” There are a seemingly endless number of reasons why millions of us are missing out on a good night’s sleep. Getting less than 6 hours of sleep has been associated with lower overall brain activity, which affects mood, focus, productivity, weight, health, and physical safety.

According to the 2009 Sleep in America Poll, Americans are averaging only 6 hours and 40 minutes of sleep each night, then squeeze in an average of 27 minutes of extra sleep on the weekends.
Even more disturbing, the percentage of people getting less than 6 hours of sleep has risen from 12% in 1998 to 20% in 2009 – while the percentage of Americans getting a good 8 hours a night has decreased from 35% in 1998 to 28% in 2009.
The numbers reveal that getting a good night’s sleep is becoming little more than an elusive dream for many Americans. Chronic sleep problems affect millions of us. Temporary sleep issues are even more common and will affect almost every one of us at some point in our lifetime.
Here are a few of the most common reasons for sleep deprivation:

1. Medications: Many medications including asthma medications, antihistamines, cough medicines, anticonvulsants, and many others disturb sleep.
2. Caffeine: Too much caffeine from coffee, tea, chocolate, or some herbal preparations — especially when consumed later in the day or at night — can disrupt sleep.
3. Alcohol, nicotine, and marijuana: Although these compounds initially induce sleepiness for some people, they have the reverse effect as they wear off, which is why you may wake up several hours after you go to sleep.
4. Restless Legs Syndrome: A nighttime jerking or pedaling motion of the legs that drives a person’s bed partner crazy (as well as the person who has it).
5. Women’s issues: Pregnancy, PMS, menopause, and perimenopause cause fluctuations in hormone levels that can disrupt the sleep cycle.
6. Chronic pain conditions.
7. Untreated or under treated psychiatric conditions such as obsessive-compulsive disorder, depression, or anxiety.
8. Alzheimer’s disease: Dementia patients “sundown” or rev up at night and wander.
9. Chronic gastrointestinal problems, such as reflux.
10. Men’s issues: Benign prostatic hypertrophy causes many trips to the bathroom at night, which interrupts slumber.
11. Snoring: Snoring can wake you or your sleep mate, or everyone in the house if it is really loud.
12. Sleep apnea: With this condition, you stop breathing for short periods of time throughout the night, which robs you of restful sleep and leaves you feeling sluggish, inattentive, and forgetful throughout the day.
13. Shift work: Nurses, firefighters, security personnel, customer service representatives, truck drivers, airline pilots, and many others toil by night and sleep by day. Or, at least, they try to sleep. Shift workers are especially vulnerable to irregular sleep patterns, which leads to excessive sleepiness, reduced productivity, irritability, and mood problems.
14. Stressful events: The death of a loved one, divorce, a major deadline at work, or an upcoming test can cause temporary sleep loss.
15. Jet lag: International travel across time zones wreaks havoc with sleep cycles.

Chronic pain is a very common cause of sleeplessness as it pertains to Chiropractic patients.  It is very rare to see a patient's condition improve and not see a drastic change in their sleep patterns.  With that in mind, many of these patients had sleeping issues prior to the level of pain that brought them to our office.  In short, they did not always associate their physical condition with their sleeping condition.    

Dr. David Marcon

Marcon Chiropractic & Wellness Center

www.marconchiropractic.com