When the pain from a chronic back problem or compressed nerve won’t go away, your doctor may recommend an injection of corticosteroids to the area.  At first glance, a steroid injection seems like a fairly good option.  It is considered medically safe, it can relieve the inflammation and therefore the pain, and it helps you avoid having to undergo a surgical procedure.  But now, on top of the recent outbreak of fungal meningitis in certain batches of steroid injections,1¹Greg McCune. “Meningitis outbreak spreads to 19 states with case in Rhode Island.” Reuters. 29 Oct 2012. (Accessed 29 Oct 2012.)  <http://www.reuters.com/article/2012/10/29/us-usa-health-meningitis-cases-idUSBRE89S10920121029> new research has found that there may be a long-term problem associated with these shots that won’t be resolved when the meningitis danger is settled.  The study determined that epidural steroid injections may significantly increase a patient’s risk for bone fractures in the spine.2²”Steroid Injection Linked to Increased Risk of Bone Fractures.” Science Daily. 25 October 2012. Accessed 28 October 2012. <http://www.sciencedaily.com/releases/2012/10/121025095014.htm>.

The research, conducted at the Henry Ford Hospital in Detroit, Michigan, involved analyzing the medical records of 6,000 people who received treatment to relieve back pain between 2007 and 2010.  Exactly half of those patients were given at least one injection of a corticosteroid in the problem area and the other half were treated with other methods and no injections.  The subjects consisted of 3,840 women and 2,160 men, and had an average age of 66.

By examining the occurrence of bone fractures to the spine in each group of patients, the scientists applied the survival analysis technique, a specific statistical approach to the data.  The findings indicate not only that the steroid injections increase the risk of a bone fracture, but that each shot may up this risk by 29 percent. Since these are patients who already have major back issues, including degenerative disks, osteoporosis and arthritis, the elevated instances of damage to the bones of the spine could be potentially devastating.  A fracture in the spine can impinge upon the nerves or spinal cord, resulting in numbness, severe pain, muscle weakness, and even paralysis.3³”Spinal fractures.” Mayfield Clinic. February 2010. Accessed 29 October 2012. <http://www.mayfieldclinic.com/PE-SpineFract.HTM>.

With a condition that weakens the bones, osteoporosis sufferers in particular are at risk for spinal fractures.  This is a common complication for osteoporosis patients, especially among women who are 80 or older.  Vertebral fractures occur in approximately 40 percent of this population.4⁴Old, Jerry L. and Calvert, Michelle. “Vertebral Compression Fractures in the Elderly.” American Family Physician. 1 January 2004. Accessed 29 October 2012. <http://www.aafp.org/afp/2004/0101/p111.html>.  And it’s a little crazy to even consider that those with osteoporosis are given steroid injections, since previous research from 2003 and even earlier has found that steroids can lead to bone loss.5⁵  In other words, these patients may end up trading some short-term relief from pain and improved mobility for fractures down the road that can lead to major long term nerve problems that require surgery.

But what is a person with chronic back pain to do?  Your physician may initially recommend a nonsteroidal anti-inflammatory medication and a course of physical therapy.  Trying physical therapy may be beneficial in many cases, as the guided exercises can stretch and strengthen supporting muscles and improve posture.6⁵”Diseases and Conditions.” Cleveland Clinic. Accessed 29 October 2012. <http://my.clevelandclinic.org/disorders/back_pain/hic_what_can_physical_therapy_do_for_your_back_and_neck_pain.aspx>.  NSAIDs, however, are not the safest option, even in their over-the-counter forms.  Of course, most of us have popped a couple of ibuprofen on occasion to relieve muscle discomfort.  But, according to the New England Journal of Medicine in June of 1999, “It has been estimated conservatively that 16,500 NSAID-related deaths occur among patients with rheumatoid arthritis or osteoarthritis every year in the United States.”7⁶Bystrianyk, Roman. “More Hospitalized from NSAID Bleeding than All American War Casualties.” Health Sentinel. 10 January 2010. Accessed 29 October 2012. <http://www.healthsentinel.com/joomla/index.php?option=com_content&view=article&id=2668:more-hospitalized-from-nsaid-bleeding-than-all-american-war-casualties&catid=5:original&Itemid=24>.  For more on the dangers associated with aspirin and the other NSAIDS, check out Jon Barron’s newsletter on the subject.

A natural option that is much safer, yet provides many of the same benefits as NSAIDs is supplementation with systemic proteolytic enzymes.  These are enzymes designed to be taken between meals so that they quickly enter the bloodstream, where they can reduce systemic inflammation and lessen pain, in addition to providing a number of other advantages.  Instead of acting to inhibit prostaglandin production as NSAIDs do to reduce pain and inflammation, proteolytic enzymes don’t disrupt the normal cycle of the body.  Instead, proteolytic enzymes work by cleaning up the excess of prostaglandins and bacteria in the bloodstream, thereby reducing pain and inflammation.

And don’t discount the simple act of weight loss.  Bones, cartilage, nerves, and a host of other body parts are overstressed and overworked when they are carrying excess weight day after day.  Being overweight may not be the root cause of most back problems, but it is definitely a contributing factor in many.  Dietary changes and an exercise routine that your doctor or physical therapist says is safe for your particular back condition may help alleviate your pain enough that you don’t require much in the way of “treatment” at all.

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1 Greg McCune. “Meningitis outbreak spreads to 19 states with case in Rhode Island.” Reuters. 29 Oct 2012. (Accessed 29 Oct 2012.) <http://www.reuters.com/article/2012/10/29/us-usa-health-meningitis-cases-idUSBRE89S10920121029>

2 “Steroid Injection Linked to Increased Risk of Bone Fractures.” Science Daily. 25 October 2012. Accessed 28 October 2012. <http://www.sciencedaily.com/releases/2012/10/121025095014.htm>.

3 “Spinal fractures.” Mayfield Clinic. February 2010. Accessed 29 October 2012. <http://www.mayfieldclinic.com/PE-SpineFract.HTM>.

4 Old, Jerry L. and Calvert, Michelle. “Vertebral Compression Fractures in the Elderly.” American Family Physician. 1 January 2004. Accessed 29 October 2012. <http://www.aafp.org/afp/2004/0101/p111.html>.

5 Jehle, Peter M. “Steroid-induced osteoporosis: how can it be avoided?” Nephrology Dialysis Transplantation. 5 May 2003. Accessed 29 October 2012. <http://ndt.oxfordjournals.org/content/18/5/861.full>.

6 “Diseases and Conditions.” Cleveland Clinic. Accessed 29 October 2012. <http://my.clevelandclinic.org/disorders/back_pain/hic_what_can_physical_therapy_do_for_your_back_and_neck_pain.aspx>.

7 Bystrianyk, Roman. “More Hospitalized from NSAID Bleeding than All American War Casualties.” Health Sentinel. 10 January 2010. Accessed 29 October 2012. <http://www.healthsentinel.com/joomla/index.php?option=com_content&view=article&id=2668:more-hospitalized-from-nsaid-bleeding-than-all-american-war-casualties&catid=5:original&Itemid=24>.