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From www.orthosupersite.com

wow... $50 million / year from Medicare?

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Epidural steroid injections limited in treating back pain, neurology society advises

Literature review finds epidural steroid injections have no impact on average functional impairment or on the need for surgery.


1st on the web (March 30, 2007)
March 2007

Epidural steroid injections play only a limited role in providing short-term relief to patients with radicular lumbosacral back pain, according to a guideline developed by the American Academy of Neurology.

"While some pain relief is a positive result in and of itself, the extent of leg and back pain relief from epidural steroid injections, on the average, fell short of the values typically viewed as clinically meaningful," said lead investigator Carmel Armon, MD, MHS, in a press release from the organization.

Armon is chief of the division of neurology at Baystate Medical Center in Springfield, Mass., and professor of neurology at Tufts University School of Medicine, Boston. He is also a member of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

Armon and colleagues performed an evidence-based literature review focusing on fluoroscopically guided transforaminal epidural injections. Of 37 articles identified, only four met the strict predetermined inclusion criteria for the study. The researchers' conclusions, based on these four studies, comprise the guideline, which is published in the journal Neurology.

The researchers found that epidural steroid injections provide some short-term pain relief between 2 and 6 weeks postinjection. However, "The average magnitude of effect is small, and the generalizability of the observation is limited by the small number of studies, limited to highly selected patient populations, the few techniques and doses studied, and variable comparison treatments," the investigators reported.

"In general, epidural steroid injections for radicular lumbosacral pain have shown no impact on average impairment of function, on need for surgery, or on long-term pain relief beyond 3 months," they wrote. "Their routine use for these indications is not recommended."

In addition, the researchers found insufficient evidence to make any recommendations regarding the use of epidural steroid injections for treating radicular cervical neck pain.

The authors noted that the review was limited by the small number of high-quality scientific studies available, and further well-designed studies are needed to determine the effectiveness of steroid injections.

"The use of epidural steroid injections to treat chronic back pain is increasing over time despite limited quality data," Armon said in the release. "Recent figures show 1999 Medicare Part B claims for lumbar epidural steroid injections were $49.9 million, for 40.4 million covered individuals."

For more information:

Armon C, Argoff CE, Samuels J, Backonja MM. Assessment: Use of epidural steroid injections to treat radicular lumbosacral pain: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2007;68:723-729.