News that contaminated steroid injections may have caused a meningitis outbreak inpatients with back pain has put health officials on high alert.

But there's another concern beneath the headlines: Whether the epidural injections should have been given in the first place.

Four years ago, medical research was inconclusive, and the American Chronic Pain Association discouraged the injections. More recent studies, however, have tipped the scale.

The Institute for Clinical Systems Improvement in Bloomington says there is only "weak" evidence in favor of steroid injections, but the organization this year advised doctors to consider them as second-line treatments after remedies such as heat, exercise and oral pain relievers have failed.

Surgery has proven ineffective at relieving back pain long-term, so doctors are looking for alternatives that reduce pain and "buy time" for patients to heal on their own, said Dr. David Thorson, a White Bear Lake physician who took part in the ICSI review of injections.

"In attempts to avoid surgery, we'll try these procedures," he said. "The time the epidural comes into play is when you have a person who is not progressing through the appropriate care of their back pain with exercise and things like that."

Determining the role of steroids in back pain treatment is critical for a nation that is getting heavier (putting more pressure on joints) and older. Low back pain is a billion-dollar problem that generates one in every five U.S. doctor visits, the chronic pain association says.

As a short-term solution in certain cases, steroids work by reducing swelling and dissolving fat buildups that pressure spinal nerves, Thorson said. The injection isn't treatment itself, but pain relief so patients can continue rehabilitation.

Doctors and patients need to weigh the benefits with the risks of side effects, Thorson said. Until recently, he hadn't considered a fungal infection with a contaminated drug to be one of those risks. 612-673-7744