Shots Fired!! Two of the most prestigious medical journals just came out fiercely against epidural injections / RFA.
The British Medical Journal just published a “Practice Guideline” paper with these damning statements:
“For people living with chronic radicular spine pain, the guideline panel issued strong recommendations against: epidural injection of local anaesthetic, steroids, or their combination.”
“For people living with chronic axial spine pain, the guideline panel issued strong recommendations against: joint radiofrequency ablation.”
The New England Journal of Medicine’s “Journal Watch” then doubled down on this stance (links in comments):
“The unfortunate reality is that some patients with chronic cervical or lumbosacral pain don’t respond to standard first-line noninvasive measures. They are understandably desperate for relief, and clinicians understandably feel obligated to “do something”.
However, none of the procedures covered in this guideline afforded clinically important pain relief with moderate certainty, according to the panel. In their concluding remarks, the authors also address the high cost of these procedures in the U.S., noting that “the substantial reimbursement… may act as a perverse incentive for their delivery.”
I’m a little bit stunned.
What do policy-makers want? For every spine patient to live eternally in a purgatory of PT and acupuncture and cognitive-behavioral therapy… even if they aren’t getting relief?
What is the impact of this philosophy on workforce productivity, long-term disability, and human misery?
Don’t get me wrong… I love the “less is more” mentality.
But do these journals/authors know the power of these words… especially when exploited by denial-addicted insurance companies?
It’s funny… a lot of conversations tend to pit spine surgeons like myself AGAINST our interventional pain colleagues.
On this day… maybe we need to band together.
Who else will act as custodians and stewards of spine care in this country?
Taif J. Mukhdomi Dr. Soubrata V. Raikar Raul Monzon MD Chris Centeno, M.D.
Filed under: General Problems
A real issue becomes clear reading this article, policymakers. Why would government officials who are not medical doctors have any say in the medical choices of individuals? Why should government promote or discourage such personal decisions?
It looks like these procedures provide relief to some people. Perhaps in our current anti-opioid these procedures are being pushed onto people who aren’t likely to respond well. If adequate opioids were readily available for people with these conditions, how many would seek invasive options?