Cost is a major concern of patients and medical insurers across all forms of health care, But it is particularly important when discussing low back pain. Not only is low back pain one of the most common complaints of patients, multiple treatments may be necessary, requiring many visits to treatment specialists. The low back pain treatment there requires the most number of physician is, in most cases, epidural steroid injections.
During epidural steroid injection for low back pain, a pain management specialist or other physician injects a corticosteroid into the space around in the spinal cord. This steroid is intended to reduce inflammation in the area around the injection and, hopefully, reduce low back pain.
While epidural steroid injections can be effective, they are not curative. Most patients need to return for epidural steroid injections every six months and, more frequently, every three months. Low back pain may be completely relieved over the first several weeks after treatment, but by the time the next injection is due, patients have as much pain as they did before the injection.
Because epidural steroid injections require so many visits and the physician is required to make the injection every time, most people have assumed that this treatment is among the most expensive. New research suggests that epidural steroid injections are not only cost-effective, but they may cut overall spending for low back pain.
A researcher from the department of anesthesiology at Stanford University reviewed cases from nearly 2 million patients with radiculitis, sciatica, and lumbago—common causes of chronic low back pain. They compared overall costs for people receiving epidural steroid injections compared those not receiving injection as part of their treatment.
Contrary to expectations, patients receiving epidural steroid injections actually experienced significant reductions in overall treatment costs. Patients with radiculitis (or their insurers) paid 16.4% less in healthcare expenditures than those who did not receive injections over a period of two years. The savings were less for those with sciatica (-7.56%) and lumbago (-4.67%), but still significant.
Importantly, while epidural steroid injections are apparently cost effective, there is only limited evidence to suggest that they are simply effective in reducing people’s pain scores. The authors of the study note that while costs were less with epidural steroid injections, there is no evidence to suggest that people improved with epidural steroid injections more so than with conventional therapy without injections.
The other important issue that the researchers note, but did not address in the research design, was that these roughly 2 million patients were not treated with surgery. While orthopedic spine surgery can be an expensive, it is a one-time cost.
While the researchers did not focus on this issue in their research, it would be interesting to determine if spine surgery for these conditions is more or less cost-effective than epidural steroid injections. Perhaps more importantly, it would be interesting to compare spinal surgery to epidural steroid injections to find out which is more effective for patients, not just cost-effective. It makes little sense to save money on procedures that do not work.
Based on previous work, it is likely that epidural steroid injections are successful for some people, but not for others. For people with low back pain who do not benefit from epidural steroid injections, low back surgery may be the answer. A critical and, as of yet unanswered question is whether it makes sense for patients and their health insurers to pay for numerous, repeated steroid injections without clear benefit. At some point, even a relatively expensive,curative orthopedic surgery saves a patient money and suffering compared to an ineffective treatment.
Determining when patients should abandon epidural steroid injections and pursue spine surgery for low back pain is a fundamental question that should be the focus of future research.