Search

Study Design.: A retrospective cohort study of utilization patterns and variables of epidural injections in the fee-for-service (FFS) Medicare population. Objectives.: To update the utilization of epidural injections in managing chronic pain in the FFS Medicare population, from 2000 to 2020, and assess the impact of COVID-19. Summary of Background Data.: The analysis of the utilization of interventional techniques also showed an annual decrease of 2.5% per 100,000 FFS Medicare enrollees from 2009 to 2018, contrasting to an annual increase of 7.3% from 2000 to 2009. The impact of the COVID-19 pandemic has not been assessed. Methods.: This analysis was performed by utilizing master data from the Centers for Medicare and Medicaid Services, physician/supplier procedure summary from 2000 to 2020. The analysis was performed by the assessment of utilization patterns using guidance from Strengthening the Reporting of Observational Studies in Epidemiology. Results.: Epidural procedures declined at a rate of 19% per 100,000 Medicare enrollees in the FFS Medicare population in the United States from 2019 to 2020, with an annual decline of 3% from 2010 to 2019. From 2000 to 2010, there was an annual increase of 8.3%. This analysis showed a decline in all categories of epidural procedures from 2019 to 2020. The major impact of COVID-19, with closures taking effect from April 1, 2020, through December 31, 2020, will be steeper and rather dramatic compared with April 1 to December 31, 2019. However, monthly data from the Centers for Medicare and Medicaid Services is not available as of now. Overall declines from 2010 to 2019 showed a decrease for cervical and thoracic transforaminal injections with an annual decrease of 5.6%, followed by lumbar interlaminar and caudal epidural injections of 4.9%, followed by 1.8% for lumbar/sacral transforaminal epidurals, and 0.9% for cervical and thoracic interlaminar epidurals. Conclusion.: Declining utilization of epidural injections in all categories was exacerbated to a decrease of 19% from 2019 to 2020, related, in part, to the COVID-19 pandemic. This followed declining patterns of epidural procedures of 3% overall annually from 2010 to 2019. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective cohort study of utilization patterns of epidural injections.Objective: The aim of this study was to assess patterns of utilization and variables of in chronic spinal pain in the fee-for-service (FFS) Medicare population, with a comparative analysis of pre- and post-Affordable Care Act (ACA) data from 2000 to 2009 and 2009 to 2016.Summary Of Background Data: Over the years, utilization of interventional pain management techniques, specifically epidural injections have increased creating concern over costs and public health policy.Methods: The master data from the Centers for Medicare & Medicaid Services (CMS) physician/supplier procedure summary from 2000 to 2016 was utilized to assess utilization patterns. The descriptive analysis of the database analysis was performed using guidance from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Multiple variables were analyzed based on the procedures, specialties, and geography.Results: Caudal and lumbar interlaminar epidural injections decreased 25% from 2009 to 2016 with an annual decrease of 4% in contrast to lumbosacral transforaminal epidural injection episodes, increasing at an annual rate of 0.3%. In contrast, lumbar interlaminar epidural injections increased 2.4% annually, while transforaminal episodes increased 23% from 2000 to 2009. The ratio of interlaminar epidural injections to transforaminal epidural injection episodes has changed from 7 in 2000 to 1 in 2016, whereas ratio of services changed from 5 to 0.7. From 2009 to 2016, cervical/thoracic interlaminar epidural injections episodes increased at an annual rate of 0.5%, with a decrease of 2.3% for transforaminal epidural injections.Conclusion: Comparative analysis of the utilization of epidural injections from 2000 to 2009 and 2009 to 2016 showed vast differences with overall significant decreases in utilization, specifically for lumbar interlaminar and caudal epidural injections, with a continued, though greatly slowed increase of lumbosacral transforaminal epidural injections.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article by Z. McCormick et al which assessed a longitudinal study of 1,021 patients receiving 1,568 transforaminal epidural steroid injections either with betamethasone or with triamcinolone with a short-term follow-up.

Background: As part of a comprehensive nonsurgical approach, epidural injections often are used in the management of lumbar disc herniation. Recent guidelines and systematic reviews have reached different conclusions about the efficacy of epidural injections in managing lumbar disc herniation. Questions/purposes: In this systematic review, we determined the efficacy (pain relief and functional improvement) of the three anatomic approaches (caudal, lumbar interlaminar, and transforaminal) for epidural injections in the treatment of disc herniation. Methods: We performed a literature search from 1966 to June 2013 in PubMed, Cochrane library, US National Guideline Clearinghouse, previous systematic reviews, and cross-references for trials studying all types of epidural injections in managing chronic or chronic and subacute lumbar disc herniation. We wanted only randomized controlled trials (RCTs) (either placebo or active controlled) to be included in our analysis, and 66 studies found in our search fulfilled these criteria. We then assessed the methodologic quality of these 66 studies using the Cochrane review criteria for RCTs. Thirty-nine studies were excluded, leaving 23 RCTs of high and moderate methodologic quality for analysis. Evidence for the efficacy of all three approaches for epidural injection under fluoroscopy was strong for short-term (< 6 months) and moderate for long-term (≥ 6 months) based on the Cochrane rating system with five levels of evidence (best evidence synthesis), with strong evidence denoting consistent findings among multiple high-quality RCTs and moderate evidence denoting consistent findings among multiple low-quality RCTs or one high-quality RCT. The primary outcome measure was pain relief, defined as at least 50% improvement in pain or 3-point improvement in pain scores in at least 50% of the patients. The secondary outcome measure was functional improvement, defined as 50% reduction in disability or 30% reduction in the disability scores. Results: Based on strong evidence for short-term efficacy from multiple high-quality trials and moderate evidence for long-term efficacy from at least one high quality trial, we found that fluoroscopic caudal, lumbar interlaminar, and transforaminal epidural injections were efficacious at managing lumbar disc herniation in terms of pain relief and functional improvement. Conclusions: The available evidence suggests that epidural injections performed under fluoroscopy by trained physicians offer improvement in pain and function in well-selected patients with lumbar disc herniation. [ABSTRACT FROM AUTHOR]

The article presents research examining the increase in the utilization and Medicare expenditures trends of spinal interventional pain management (IPM) techniques, including epidural steroid injections, facet joint interventions and sacroiliac joint interventions in multiple settings. The authors identified the number of procedures performed each year by using current procedural terminology codes from the years 2000-08. The results indicated decrease in the explosive growth of these techniques.

The article determines the clinical effectiveness of therapeutic local anesthetic cervical medial branch blocks with or without steroid in the management of chronic neck pain of facet joint origin. It shows that therapeutic cervical medial branch nerve blocks, with or without steroids, may offer effective management for chronic neck pain of facet joint origin.

A letter to the editor and a reply are presented regarding the article "Posterior Circulation Stroke After C1-C2 Intraarticular Facet Steroid Injection: Evidence for Diffuse Microvascular Injury," by B. L. Edlow and colleagues, published in a 2010 issue.

Azad I et al i [1] studied provider specialty and its association with long-term opiate use in patients with newly diagnosed low back pain. It is uncommon for pain management physicians to receive acute patients suggesting a misunderstanding of acute phase. Of note, Medicaid expansions has increased many patients' access to care with pain physicians as first providers, despite their chronicity.[2] The study does not analyze employment status of pain physicians who may work for spine surgeons thus skewing the data. [Extracted from the article]

A letter to the editor is presented in response to the article "Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: An evidence-based clinical practice guideline from the American Pain Society," by Roger Chou and colleagues in the May 1, 2009 issue, and a reply from the authors.

A letter to the editor is presented in response to the article "Efficacy of epidural perineural injection of autologous conditioned serum in unilateral cervical radiculopathy: a pilot study" by V. G. Goni and colleagues.

A letter to the editor is presented in response to the article "Cervical Medial Branch Blocks for Chronic Cervical Facet Joint Pain: A Randomized, Double-Blind, Controlled Trial With One-Year Follow-Up," by L. Manchikanti, V. Singh and F. J. Falco in the previous issue of the journal.

A letter to the editor is presented in response to the article "Is sedation indicated before spinal injections," by N. Kim and colleagues, in the 2007 issue.

A letter to the editor is presented in response to the article "Short-term Improvements in Disability Mediate Patient Satisfaction After Epidural Corticosteroid Injections for Symptomatic Lumbar Spinal Stenosis," by Pradeep Suri and colleagues in the 2015 issue.

A letter to the editor is presented in response to the article regarding the safety and effectiveness of ventral epidural filling technique in lumbar interlaminar epidural steroid injections.

A letter to the editor is presented in response to the article "Nonoperative management of discogenic back pain" by L. Yu and colleagues in a previous issue.

A letter to the editor is presented in response to the article "Randomized Study Assessing the Accuracy of Cervical Facet Joint Nerve (Medial Branch) Blocks Using Different Injectate Volumes," by Steven P. Cohen et al in a previous issue.