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Why Do Most Pain Clinics Recommend Steroid Type Treatments ???

MsHumptyDumptyMMsHumptyDumpty Posts: 1,567
edited 06/11/2012 - 8:41 AM in Chronic Pain
From all my readings and research these injections in general do not work for the majority of patients with lower back issues.... such as disk herniations, nerve damage, DDD etc etc.

and yet a large % of pain clinics offer the steroid injections as the "cure". I use the word offer loosely! My experience has been that the pain clinics DEMAND you try the injections first.

If you go against their recommendations you are now consider a uncooperative patient.

Are the pain clinics working "for" the insurance co's? Hoping that the injections work, and the insurance can avoid paying for surgery or other treatments?

To me none of this makes sense when so few find true relief from these type of treatments :??
L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.


  • Are generally tried first as a means of controlling swelling to see if this will help the pain.

    Yes, generally the PM will do these first.

    I sent you a PM, sorry I have not been on to answer your sooner. My second opinion PM did not try and make me endure more injections. The places that try and force more after you have already went through a series and found them ineffective are the places I personally would cross of my list.
  • I think we need to be careful in making broad based statements that injections don't work. While many of us have not had success with them there are many who have had them. I can understand your frustrations if you know they aren't working for you and someone wants to try them. Lots of insurance companies have protocols to treatments and the doctors know the different protocols of the insurance companies they except. So often times they are aware they have to use that protocol up front to follow the process. Keep in mind paying for a injection versus paying for surgery is a lot more cost effective. While you see your health as your body and it is very personal. No matter how you spin it is business and the cost factor on treatments is going to effect the care. The insurance companies have statistics that they use to determine a set of guide lines of protocol. If you think about the protocol of treatments in the process it is pretty straight forward that everyone goes through the same testing and same remedies. In your situation what would you like the doctor to offer you for treatment? Myself I have been with the same doc for years and he knows what is going to help and what is not. But we got to this point through a trial and error period.

    I just caution saying injections have no use or a waste of money, in all cases. The only cure I know of at our ages to revert back in time when our spines were in their youths. Any pm doc who uses the term cure in a injection setting i would walk from. I think the goal should be to lesson the pain that someone is having that is causing them to seek medical help.
  • been to the clinic yet? How is she going with the pain and coping with a new born?
    How's your grandchild doing now?
  • I have to agree that not all people have the same results. I personally did not get relief from the injections but I have several friends that have neck/back pain and the injections have helped them tremendously. One of my girlfriends goes every 4 months or so and she is as good as new once the soreness from the injection wears off. My PM tried injections on me about three times and then a ryzotomy, with no pain relief, but I would rather try something a little more conservative first then go straight for a nonconservative method.
  • My apologies :)

    I used terms like in general - majority - my research - my experiences. The intent on using these words was so I would not seem to be saying everyone.

    IMM - no she has an appt. for the 23rd .....
    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • j.howiejj.howie Brentwood, Ca., USAPosts: 1,732
    Want to avoid surgery. Until every Avenue has been traveled. They also hope to avoid the Physical dependency of drugs.
    And then of course there are the protocols.
    I,personally had good results with them in the beginning of my journey that started out with DDD. I was able to stretch my working career out 4 yrs. before things got so bad that they couldn't keep up.
    good luck,Jim
    Click my name to see my Medical history
    You get what you get, not what you deserve......I stole that from Susan (rip)
    Today is yours to embrace........ for tomorrow, who knows what might be starring you in the face!
  • Actually, I think the steroid injections work in just enough cases to make them cost effective vs. long-term pain treatment, physical therapy, or surgery.

    My PM doc doesn't just recommend them, he swears by them and gets them himself.
  • OK. I am coming to a better understanding of all this now. Thanks so much for sharing this info/experiences with me :)

    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • I have had injections, and they have failed me also. I felt they are being pushed for 2 reasons. Both brought up by one of your responders. They avoid dealing with narcotics that the Drs. seem to want to not prescribe. Pain management and no narcotics, makes sense to me, NOT. I have been given almost no narcotics. The ones that have been prescribed were done so at the lowest doses so their effectiveness was minimal. I have rarely used them so I have the annoying side effect of itching if I take anything to a level of actually helping. The 2nd reason is obvious as stated here. Anything to avoid surgery, which I have to agree with. I myself would avoid it at all costs. I was recently put on lyrica and I never felt my symptoms matched up with that as well as myofascial pain syndrome. MY PCP put me on lyrica 75mg twice daily up to 150mg twice daily, after pain management Dr. said it was possible I had that along with other stuff, since my symptoms didn't match up with my spine issues alone. He also felt they were messed up, and wasn't sure about the injections. But hey what the heck lets just stab away. NOT. so good luck, I feel your frustration and pain. I will be 50 this month. I had to file for disability at 47, after working since 14. I live in NY so it is a hard state to get qualified. It is the worst process to go through along with being "sick" and told you can't work anymore, even part time. My neurologist is the one who told me this. I didn't believe him at first, but as time passed I realized he was right. If you would like to chat, I would be up for that. Candrews
  • What tamtam said, My first surgery, my laminectomy, I wanted something done then, and they were like Woahh, the insurance company won't approve things like surgeries till you exhaust all the other treatment options, aka epidurals. And epidurals did work on me in the beginning now, last maybe a day or so now.

    They had this article in readers digest about how epidurals have jumped up like 3 times the amount they were 5 years ago, and they have done studies where they were shown to be ineffective. But till the insurance companies get that thru their head they will keep forcing them on their patients. I have a relative thats a PM that does epidurals, he loves them because easy money. They make ALOT of money from those epidurals.
  • dilaurodilauro ConnecticutPosts: 9,875
    and if the team of doctors you are not seeing wants to jump into Surgery first, I would walk away.

    Spinal Injections like many of the other conservative treatments provide benefits for some people but not everyone. Just like how some people benefit from Physical Therapy while others dont.

    With todays Health care system in USA, the Insurance companies lay out many of the guidelines that physicians are required to follow.

    Many companies would not 'approve' the cost of surgery if conservative methods were not tried first. Of course in times of an emergency, the surgery would be performed.

    Besides being a conservative treatment, many doctors use the spinal injections as a diagnostic test. They are looking to see if the patient has any pain relief from those injections.

    Look at this analogy:

    Your car is having problems running smoothly. It sputters and chokes a bit. You bring it to a mechanic to have them look at it. Would you want them to immediately replace your carburetor, all you fuel lines, gas tank, etc. Or would you want them to try simpler things first, such as changing a fuel filter, adding some fuel treatment.

    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • When I first started with my lumbar issues, I had multiple kinds of pain including sciatica down both legs, but mostly down my left leg, could barely walk especially when I first got up in the morning. I also had lower back pain, and hip pain.

    I had multiple injections for various things trying to get rid of all the pain. Although nothing helped with the lbp and hip pain, the ESI permanently got rid of al the sciatic pain I had. I ended up having surgery for facet joint problems and stenosis, but the pain that came from my bulging disc was fixed with the ESI.

    So they really can work and I would hope that anybody that has spine problems would agree with their doctor that it's imperative to try all conservative treatments before agreeing to have surgery. Surgery is absolutely the last resort.

  • Thanks all for opinions, thoughts & experiences. It has broaden my range of knowledge about these :)

    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • Im not a fan of pain management clinics. I think they offer the steroid or other injections over and over to a patient because it is what they specialize in, its what they do that other doctors do not. Just my opinion going from my experience. Some people get great results from these injections. Ive probably had nearly ten which have all did nothing.
  • My pain management doctor says at least half of patients get some relief. If you look at actual research, that's better odds than most medications and a lot of surgeries have.

    So you can look at it as "there's a 50/50 chance this will do nothing for me" or "there's a 50/50 chance this will really help."

    For what it's worth, placebo effect is a real benefit but doctors aren't allowed to prescribe placebos. Anyway, any procedure or med works better if the doctor convinces you it will, because you will get both the mind over matter effect and whatever effect the medication grants.
  • ...is the lack of a definitive diagnosis. I believe most of us here from what I have read all suffer from that in one form or another. Until the MRI or test screams out the cause than we are left in "limbo". From the first day it made no sense to me in that without a definitive diagnosis how can you create a remedy. Instead we are just hoping for time and luck to heal us. Hence they give us all these shots to just keep us going in the hope. So many cases seem to be that after several years of pain and suffering, final the surgery and than they find out what was wrong all along.

    It reminds me of when I was young and for many years I suffered from IBS...it really is not a diagnosis but instead a catch all phrase meaning you have a sensitive stomach. Hopefully like my IBS it will eventually fade but that took more than 10 years. I think many times I hear the term DDD, from what I read we all have that in one form or another as we get older.

    It just bothers me with all our advances in medicine and technology we are still clueless to the causes of back pain.

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