(Editor’s note: Last month, PNN reported on the “Post-Surgical Injections as an Opioid Alternative Act,” one of dozens of bills Congress is considering to combat the opioid crisis. HR 5804 would raise Medicare’s reimbursement rate for epidurals and other spinal injections used to treat post-surgical pain. The bill – which was lobbied for by doctors who perform the procedures – has drawn little public scrutiny and was rushed through a congressional committee after one brief hearing.)
By Denise Molohon, Guest Columnist
Raising the reimbursement rate for post-surgical spinal injections would dramatically increase healthcare costs and disability rates. This is based on historical research and medical evidence.
A harmful procedure should never be considered a “standard of care” by the medical profession. Yet that is what has happened with epidural steroid injections (ESIs) and Congress is going along with it under the guise of preventing opioid addiction.
“In the United States, more than ten million epidural steroid injections are delivered each year, a number that makes them the bread and butter of interventional pain management practices,” wrote Cathryn Jakobson Ramin, author of “Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery.”
The National Health and Medical Research Council of Australia warned in 1994 that the risk of a dural puncture of the spinal cord during an injection was at least 5 percent. It also cautioned that “particular care must be taken if attempting an epidural injection in patients previously treated by spinal surgery.”
In such cases, an epidural steroid injection (ESI) carries a very high risk of direct entry into the subarachnoid space, which can have catastrophic consequences to a patient, including the development of Adhesive Arachnoiditis, a chronic, painful and disabling inflammation of spinal nerves. I live with that condition, along with a growing number of other patients.
“The incidence of arachnoiditis has risen about 400% in the past decade,” says Forest Tennant, MD, Editor Emeritus of Practical Pain Management.
Between 2000 and 2011, there was a staggering 665% increase in the rate of lumbar and sacral epidural injections among Medicare beneficiaries. The data also show that there were enormous increases in spinal injections performed by physical medicine and rehabilitation specialists.
“We are doing too many of these, and many of those don’t meet the proper criteria,” Dr. Laxmaiah Manchikanti told The New York Times in 2012. Manchikanti runs a pain clinic in Paducah, KY and is chairman of the American Society of Interventional Pain Physicians – which lobbied for HR 5804 and gave campaign contributions to its sponsors. He told The Times about 20 percent of doctors who perform ESIs are not adequately trained.
The growing use of spinal injections has not resulted in better care. Dr. Richard Deyo, a professor of family medicine at Oregon Health and Science University, told the The Times that “people with back pain are reporting more functional limitations and work limitation, rather than less.”
HR 5804 is more bad policy piling on top of an already failed campaign of opioid legislation — much of it based on misinformation provided by the CDC — that will perpetuate the tsunami of needless pain and overdose deaths.
It needs to stop. Today.
When profit is one of the major motivating factors of those seeking new legislation, those creating the legislation and those lobbying for it need to be questioned. Profitability should never play a factor in any treatment plan. However, it now seems to dominate the American healthcare system from diagnosis to testing to medication.
This needs to change.
Medicine needs to be removed from the hands of lobbyists, PAC’s, and politicians and put back into the hands of the personal physician and his or her patient. It should be as individualized and unique as the medical needs of each patient.
It truly is that simple.
Neither the FDA nor the founder (Upjohn) of the drug Methylprednisolone recommends this medication to be used in ESI’s. And according to the 1994 Australia study… and the number of ESI given every year… we can expect abt 500,000 new pts developing Adhesive Arachnoiditis… which results in the pt becoming a intractable chronic pain pts.. which is IRREVERSIBLE !!! So Congress – in an attempt to address the pseudo opiate addiction crisis – is causing the potential of 500,000 pts to be in need of 24/7 opiate therapy…. just the opposite effect that Congress of what is the apparent attempt of Congress..
This is an election year… and one has to wonder how much money had to change hands to get this bill passed by the House ?
Just remember that all 435 members of Congress are up for re-election in November- except those that have chosen to not run and jump ship before it sinks 🙂
Hopefully, when the bill gets to the Senate… the Democrats… who have not agreed to vote with the Republicans… will continue on this bill… and it will fail to get passed
Filed under: General Problems
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