Are epidural injections phasing out

[SpineBros]

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Lately I’ve been seeing more studies coming out showing that epidurals aren’t all that effective, especially long term. Honestly, in my experience, they don’t do much for most patients, maybe some temporary relief, but nothing major. A lot of patients just go along with it because they don’t know what else to try.





Also, I’ve noticed social media (especially the more “woke” corners) going hard on the fact that epidurals aren’t FDA approved and might even do more harm than good.





Got me thinking — where is pain medicine headed? Are we moving past these legacy treatments or just stuck in the cycle?

 

[schmee90]

yeah epidurals are gonna be gone in a few years. Chiro, acupuncture, shoe lifts for leg length discrepancies, and PTs diagnosing patints with piriformis syndrome who have huge disc extrusions will replace us in the near future

(added color of sarcasm)

 

[BoardingDoc]

Lately I’ve been seeing more studies coming out showing that epidurals aren’t all that effective, especially long term. Honestly, in my experience, they don’t do much for most patients, maybe some temporary relief, but nothing major. A lot of patients just go along with it because they don’t know what else to try.





Also, I’ve noticed social media (especially the more “woke” corners) going hard on the fact that epidurals aren’t FDA approved and might even do more harm than good.





Got me thinking — where is pain medicine headed? Are we moving past these legacy treatments or just stuck in the cycle?

I also heard that Tylenol is going to be going the way of the dodo soon. I mean, yeah, it gives some temporary relief but nothing major. We should probably stop using it.

 

[drusso]

Most people are phasing out ESI's and doing platelet lysate epidurals instead.

 

[Ducttape]

oddly enough, still an epidural....

 

[SSdoc33]

Most people are phasing out ESI's and doing platelet lysate epidurals instead.

Not sure you know what ‘most’ means

 

[lobelsteve]

Not sure you know what ‘most’ means

He meant moist people.

 

[clubdeac]

Just saw a patient back today who has severe L4-5 stenosis. Saw her 18 months ago. Reports 90% relief from ESI and PT and asking for another shot

 

[Kissmyabjj]

ESI’s are life-changing in the right patients

 

[Blackmateria]

I feel like they will stick around as long as insurance and spine surgeons consider them "conservative care". Better a few epidurals than a costly surgery.

 

[Dr. Ice]

Maybe they should phase out spine surgery..doesn’t really work long term on anyone

 

[mille125]

ESI’s are life-changing in the right patients

agreed

 

[MitchLevi]

Epidurals are medically necessary.

 

[powermd]

First- If you're doing anything interventional in an opiate desiring or otherwise "secondary gain" population- your results are going to suck.

Second - what's your threshold for "temporary" pain relief to be worth the (minimal) risk and expense? I would say 3 months of pain relief without daily mind-altering meds is adequate and sustainable for most people. Worried about steroids? Lower the dose. Probably doesn't matter that much anyway. On the other hand- what about 6+ months of pain relief? That sounds like an awesome deal to me. My brother in law is going on 9 years of relief now since I did a single L5-S1 shot for an L4-5 disc that had been bothering him for a year. I've had a great run with epidurals lately- so many patients coming back saying "you don't know what it means to me not to have this pain".

So go ahead and crap on epidurals because they don't work in your depressed, opioid-dependent, cigarette-smoking, dark-glasses wearing, power chair rolling, lipstick-on-the-rim of their DD iced-hazelnut triple latte obese end-stage fibromyalgia Medicaid patients. If Oz manages to get them non-covered- great, I'll charge cash, get paid more fairly, and do less busywork for it. But the market for this procedure will always be there.

 

[hopefulgasman]

The epidural is my procedure with the highest success rate. Duration of relief is a different story, but it works every time.

 

[Laryngospasm]

Good news is a 100k back surgery that’s makes them worse will always be available..

 

[epidural man]

dark-glasses wearing, power chair rolling,

Haha. Hilarious….

 

[bedrock]

So go ahead and crap on epidurals because they don't work in your depressed, opioid-dependent, cigarette-smoking, dark-glasses wearing, power chair rolling, lipstick-on-the-rim of their DD iced-hazelnut triple latte obese end-stage fibromyalgia Medicaid patients. If Oz manages to get them non-covered- great, I'll charge cash, get paid more fairly, and do less busywork for it. But the market for this procedure will always be there.

This is awesome…and true

 

[Blackmateria]

So go ahead and crap on epidurals because they don't work in your depressed, opioid-dependent, cigarette-smoking, dark-glasses wearing, power chair rolling, lipstick-on-the-rim of their DD iced-hazelnut triple latte obese end-stage fibromyalgia Medicaid patients. If Oz manages to get them non-covered- great, I'll charge cash, get paid more fairly, and do less busywork for it. But the market for this procedure will always be there.

English literature truly lost a genius when you went into medicine.

 

[interjectionreflection]

Epidural Steroids for Cervical and Lumbar Radicular Pain and Spinal Stenosis Systematic Review Summary: Report of the AAN Guidelines Subcommittee - PubMed

Thought this is relevant to the discussion. For what it worth I still think ESI are beneficial for the right patient. I have seen tons of people go back to living a fulfilling life less limited by pain after ESI. Most reviews imply otherwise but I still feel real world response is better in the right person. Key being right patient -- clear goals, motivated, no yellow flags, realistic expectations and working on physio