I havent performed any MILD procedures, so I cannot comment. I also find this discussion very relevant.
As a hospital based pain physician catering to 20+ PCPs, I often find myself defending IPM. They think that pain physician should write ONLY medications since "injections dont work". We do prescribe, when its appropriate, but our true role is that of a diagnostic physician. Not just injecting.
After giving it much thought, IPM, despite not having level 1 evidence for every procedure, is the most common sense, cost effective and sensible approach to pain management.
What else is there? opioids?? whats the end point on opioids?? surgery?? accupuncture??
Ofcourse weight loss, stress management are critical - but we rarely get a thin, slender, working patient with a full time job. And when we do, they respond beautifully to injections. Most of our patients present with clinical situations where there is not an easy solution.
I have been fortunate enough to have excellent results from my procedures - and I do not say it to gloat, but my referring physicians tell me often. I say this simply because a) there is clear indication to do the procedures, b) patient was educated on the procedure and other alternatives. c) risks and benefits and expectations were made clear d) I do not inject everyone - esp. where I feel the patient is unlikely to benefit.
I feel that at the individual patient level, it is impossible to discuss these studies, because if that patient improves even 30% from the procedure + atleast 30% placebo effect from someone actually giving a **** about their condition and doing something + meds/ weight loss/ CBT+psychological treatment, the patient has already improved.
The choice to perform an appropriate and indicated procedure is based completely on the patient's history and comorbid condition, maybe exam and imaging, and what they want, and psychosocial profile.
To me that is enough of a criteria to perform the procedure since the actual risk of our procedures is very low.
