FDA: Epidural Steroid was Off-Label Use? Really? It Was NEVER Approved for That?

Oh I thought I can take a day off from typing up blogs but wow!!! Things come at me from friends and colleagues with the speed of light. I am outraged! So here is a new killer article for you!

Who ever in his or her mind would have thought that epidural steroid injections that many insurance companies request to be given prior to surgery were never ever FDA approved procedures?!

Oh my!! Now there is big trouble! Because they were not approved!

There is big trouble on two fronts and let me list them in order of importance where off-label use is number one!

  1. Off-label use of any drug should be illegal! We now have seen several examples where off-label use of a drug hurts people. I have written about off-label use before but let me cover it again in the quick. When the FDA approves a drug, it has extremely strict guidelines for everything, including label which must contain what it is to be used for; how it is used; each dose has a separate label; all adverse reactions must be listed. Nothing can change on this label unless the FDA says it must be changed and when the FDA says it must be changed that is bad news! There is an inconsistency in the labeling of FDA that allows an innocent appearing sentence: “your doctor may prescribe this for causes other than listed” or something similar. This is an under-the-table permit for off-label use. But this is a double-edged sword. On the one hand, the drug is not permitted to be used for anything that is not included on the label and on the other hand it permits the drug to be used for things that are not on the label. I wonder why lawyers are not yet chewing at this sentence from all angles? Is that possible they have not noticed the logical inconsistency? Lawyer? Not noticing? Nah….
  2. The steroid injections used in epidural form to be injected into the spine are now black-boxed by the following strong statement by the FDA:

Injectable corticosteroids are commonly used to reduce swelling or inflammation. Injecting corticosteroids into the epidural space of the spine has been a widespread practice for many decades; however, the effectiveness and safety of the drugs for this use have not been established, and FDA has not approved corticosteroids for such use

Let me rephrase this making my point: Injecting corticosteroids epidural has been a widespread practice for many decades but FDA has not approved corticosteroids for such use. Wow! They have killed two birds in one swell swoop!

On the one hand they admit to allow an FDA non-approved process to happen and sort of encouraged it for decades??? For decades??? As a widespread practice? And on the other hand they have strict guidelines that will not allow a dot to be changed on the label and all drugs must be approved by the FDA prior to use?

Am I missing something here?

Will someone please tell me why we need to have the FDA? Does it have any reason to exist and oversee the safety of our drugs with such double standard? They look the other way for decades over illegal use of a procedure that ended up hurting people? Oh yeah. Let’s talk about the kind of injuries:

[04-23-2014] The U.S. Food and Drug Administration (FDA) is warning that injection of corticosteroids into the epidural space of the spine may result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death.

Oh I am tickled to tears to know that after decades of people getting hurt the FDA finally puts a new label out–not that it prevents its use even though it admits it does not show any benefit yet either: “the effectiveness and safety of the drugs for this use have not been established” so my question is dear FDA: Why are you letting a drug that is so dangerous as a result of its procedure to be continued?

Those of you who are told by your insurance companies that you should try an injectible corticosteroid epidural before other procedures, please print this article and hand it to your medical provider along with a note that the medical provider and your insurance company must sign: in case I get injured you are all responsible in court! I think you will not be forced to have that injection after all!

And if you are an attorney, please do yourself and the rest of all a huge favor and start a class action lawsuit! This is your chance!

Comments are welcomed and encouraged!!!



About Angela A Stanton, Ph.D.

Angela A Stanton, PhD, is a Neuroeconomist focusing on chronic pain--migraine in particular--physiology, electrolyte homeostasis, nutrition, and genetics. She lives in Southern California. Her current research is focused on migraine cause, prevention, and treatment without the use of medicine. As a forever migraineur from childhood, her discovery was helped by experimenting on herself. She found the cause of migraine to be at the ionic level, associated with disruption of the electrolyte homeostasis, resulting from genetic variations of all voltage dependent channels, gates, and pumps (chanelopathy) that modulate electrolyte mineral density and voltage in the brain. In addition, insulin and glucose transporters, and several other variants, such as MTHFR variants of B vitamin methylation process and many others are different in the case of a migraineur from the general population. Migraineurs are glucose sensitive (carbohydrate intolerant) and should avoid eating carbs as much as possible. She is working on her hypothesis that migraine is a metabolic disease. As a result of the success of the first edition of her book and her helping over 5000 migraineurs successfully prevent their migraines world wide, all ages and both genders, and all types of migraines, she published the 2nd (extended) edition of her migraine book "Fighting The Migraine Epidemic: Complete Guide: How To Treat & Prevent Migraines Without Medications". The 2nd edition is the “holy grail” of migraine cause, development, and prevention, incorporating all there is to know. It includes a long section for medical and research professionals. The book is full of academic citations (over 800) to authenticate the statements she makes to make it easy to follow up by those interested and to spark further research interest. It is a "Complete Guide", published on September 29, 2017. Dr. Stanton received her BSc at UCLA in Mathematics, MBA at UCR, MS in Management Science and Engineering at Stanford University, PhD in Economics with dissertation in neuroscience (culminating in Neuroeconomics) at Claremont Graduate University, fMRI certification at Harvard University Medical School at the Martinos Center for Neuroimaging for experimenting with neurotransmitters on human volunteers, certification in LCHF/ketogenic diet from NN (Nutrition Network), certification in physiology (UPEN via Coursea), Nutrition (Harvard Shool of Public Health) and functional medicine studies. Dr. Stanton is an avid sports fan, currently power weight lifting and kickboxing. For relaxation (yeah.. about a half minute each day), she paints and photographs and loves to spend time with her family of husband of 45 years, 2 sons and their wives, and 2 granddaughters. Follow her on Twitter at: @MigraineBook, LinkedIn at https://www.linkedin.com/in/angelaastantonphd/ and facebook at https://www.facebook.com/DrAngelaAStanton/
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4 Responses to FDA: Epidural Steroid was Off-Label Use? Really? It Was NEVER Approved for That?

  1. Well said Angela! You took the words right out of my mouth…. Brava!

    Dennis J. Capolongo
    Director / EDNC

    Liked by 1 person

  2. working too hard says:

    Angela. off label use of drugs are more prevalent that you realize. there simply are not the dollars or manpower to study every drug to see if it is effective for every indication.

    Liked by 1 person

    • That may be true “working too hard” but given that it is a drug and drugs require FDA approval “as per label specifications” very strictly, they are illegal. The recent epidural steroid injections – you see in this article – were even required prior to any alternatives by some insurance companies and now FDA says they were not even approved. Now the FDA is complaining contradicting its own statement. Legally the FDA gets away with off-labeling by having the pharmaceuticals put on the label “your doctor may prescribe this drug for other conditions not listed” yet when this actually hurt people – as in the epidural steroids they did – The FDA points fingers immediately stating “it was not approved for that purpose.” One cannnot go both left and right at the same time neither legally nor ethically.


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