I went to a pain clinic hoping to find some relief for my neck pain. A friend had suggested steroid injections that seemed to help her. Instead all I got was a recommendation to take Tylenol, adjust my posture, and come back in three months. They gave me a letter saying these are their current recommendations in an effort to stop the overutilization of injections. I was pretty flabergasted to say the least. Should I try going somewhere else?
It sounds like the pain clinic has made some policy changes based on a recent study published by the University of Colorado School of Medicine. The study was done because it has become obvious that spinal steroid injections, nerve blocks, sacroiliac joint injections, and heat treatments to kill nerve endings have reached explosive numbers. For example, they showed that in a 12-month period of time almost one million of these interventionalprocedures were done on 200,000 patients. The patient database used for this study only included privately insured patients. Medicare, worker's compensation, motor vehicle insurance, and Veterans Administration were not included. About 12 to 14 million people from all 50 states were represented in this study. And that only represents about five per cent of the total U.S. population surveyed. So it's likely that many, many more of these interventional spinal procedures are really being done. But is that so bad? Perhaps these numbers reflect the fact that physicians have found a treatment that works for back pain. And once they sharpen their skills by doing more of these procedures, their results improve. Word spreads and more people seek their services. That is one possible scenario. But the authors of this study think it's more likely that a small number of physicians have found an easy way to make a profit. They suggest that overutilization of these procedures is contributing to the high cost of health care without corresponding high-quality evidence to support this treatment. Here's a closer look at what they uncovered. Only a few providers are responsible for a disproportionately high number of interventional spinal procedures. Neurologists and pain specialists are at the top of the list for the number of these spinal procedures that are done. In fact almost 40 per cent of all spinal pain procedures mentioned here are done by this small group of physicians. What is the significance of these findings? The bottom-line in the economics of health care is preventing overutilization and cost containment. This study showed that a small number of providers are responsible for a large number of interventional spinal procedures for back pain. This pattern of high utilization may represent overutilization and may be behind changes in this pain clinic's policies. Studies like this help shape health care policy by calling for accountability that includes reasonable and justifiable treatment guidelines. There is no reason not to seek a second opinion. There may be individual factors in your case that would still suggest steroid injections is the appropriate treatment. Don't be surprised though if you get the same response as the staff at the first clinic offered. Most of the research to date shows that this type of conservative approach really does work best for most people.