Injecting for Dollars

So, we all love to refer chronic backpaineurs to ortho or neuro or pain management or whomever for epidural steroid injections for sciatica.  It offers people something besides pain meds and boring physical therapy but not so radical as surgery.  We’d love to believe that they work and help people – ideally keeping them out of the ER for their chronic problem.  The providers that do them also love to believe that they work – pts would be happy and the money they make from doing a relatively simple and safe procedure (the exception is the risk of fungal meningitis due to contamination of the drug) is awesome!   Of course that financial motivation is going to drive doing the procedure.

Now a pretty big study out of the Annals of Internal Medicine shows that in all likelihood, these injections don’t work.   They may provide short term relief but offer no significant long term benefit.  Now, some providers might like this since it means they can do repeat injections on patients when the first one wears off but I don’t see it that way.   I see the whole thing as a big scam.  And let me tell you, many doctors out there are in on this sort of thing.  All the money in medicine these days is on procedures so everyone wants a piece of this pie.  You make diddly squat using your brain in medicine and all in using your hands.  Human nature cannot avoid this lure so doctors do procedures – often of unclear or unproven benefit to patients who are often desperate for relief from their problem – be it chronic back pain or prostate cancer or whatever.  Insurance companies are pressured to cover these things and when docs all opt to be out of network, the company pays them BIG TIME  – often ridiculous amounts. Payments of near 100K for a routine, non-emergent multilevel back surgery are not uncommon.  Of course an injection pays much less but it’s simple!  It takes three seconds!  Do 20 of them in a day and CHA-CHING!

Until we change the way we reimburse for medical services and start to value the brain as much as the hands, this will never stop. We’ll just move on to the next cash cow.

10 Responses to Injecting for Dollars

  1. Stephanie says:

    Trust me, I would love it if there was a way to fix my husbands back pain. (T7 Compression Fracture to 40%, well healed 10 years ago). We know the injections won’t fix a thing, but they do give him enough relief to move and bend.

  2. Officer Cynical says:

    The one time I had a cortisone injection for an on-duty elbow injury, there was no question about me going back for more. The cortisone didn’t work, but the injection hurt so damn bad I learned to live with the achy elbow rather than try it a second time.

  3. C says:

    So what does work? Lots of herniated disks and tears after an mva. Tried everything and pain management really interferes in working.

  4. Leslie says:

    Agreed. I’ve had the injections, didn’t help. I wish I could find a doctor that was really interested in trying to figure out my problem. Each specialist has their own idea or theory.

  5. BubbleGirl says:

    For damaged cartilage, tendons, and ligaments (including herniated discs), try prolotherapy injections (by someone with lots of prolotherapy experience). They actually promote a healing response that grows you new tissues.

  6. C says:

    Had prp for a bicipital tendon tear. Helped for the first few months. Now I think it’s torn again.

  7. To think we’re going down the same route in England, away from a system that works to a system where people know the price of everything & the value of nothing. Must be mad. It doesn’t work in the USA, unless you’ve got money, why should it work here.

  8. AlmostJesus says:

    The injection provides a meaning response. For those that believe that it will work for them, it will provide them at least some relief due to the meaning behind the procedure. The ritual of the injection provides the belief within the patient that the injection will help them.
    Check out the SMART EM podcast on the Placebo Paradox and the book Meaning, Medicine, and the Placebo Effect by Daniel Moerman

  9. Nurse Meninges says:

    And, if you’re really lucky, you’ll get fungal meningitis, have a stroke, or seem to get better and then develop a nice pus filled pocket along your spine.

  10. Amy says:

    I had one of those injections in my hip. Horribly painful and not helpful, made me determined never to see an orthopedist again. I eventually figured out I could stop my hip pain by using a particular strength training machine at the gym.

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