Today’s NYT arrived with the news that injecting steroids is not much more effective in treating back pain than injecting saline.
Yet one of the most common approaches to “treating” back pain is the epidural steroid injection (ESI), with tens of thousands of patients subjected to the procedure – and its attendant risks (spinal cord injury, paraplegia, quadriplegia) – every year.
While those who got the steroid injection did fare somewhat better than those who got alternative treatments (saline or etenercept injections), but the difference was not statistically significant, and leg and back pain actually decreased in all three groups. Here’s how the authors summarized the findings:
“More patients treated with epidural steroids (75%) reported 50% or greater leg pain relief and a positive global perceived effect at 1 month than those who received saline (50%) or etanercept (42%) (P = 0.09).”
It is likely that ESIs help some patients, it is also abundantly clear that far too many are done. Given the real risk of spinal cord injury and other nasty adverse outcomes, payers would be well-advised to ensure patients are very well-informed, and providers are cognizant of the research before going thru with this procedure.
What does this mean for you?
More evidence that far too much of what passes for medicine is based on opinion and not science or research. Time to update your list of procedures subject to pre-cert.
May
1
This is valuable information. Far too many ESI’s are done. The real test here is what we do with the information. Unfortunately in Workers’ Compensation far too much medical is done on what sounds right rather than what is right.
Not sure if you care but a p value of greater than 0.05 is not statistically significant. Smells like a good opportunity to do more research.
Speaking from personal experience of someone that has multiple herniated disks and over the years has had many EPIs (not all of them effective), they did put off my inevitable 4 level fusion for about 20 years! I would definitely have another one to ward off further suregery!