Newswise — MIAMI, FL: Thousands of patients with low-back pain could be left without access to potentially helpful treatments as a result of a recent study by the Agency for Healthcare Research and Quality (AHRQ) that is likely to influence reimbursement decision making.
Pain specialists at the 14th Annual Pain Medicine Meeting in Miami, FL, this past week, explained why the “AHRQ Technology Assessment Report: Pain Management Injection Therapies for Low Back Pain” is flawed and steps that the American Society of Regional Anesthesia and Pain Medicine (ASRA), along with 13 other pain medicine groups, collectively known as the Multisociety Pain Workgroup (MPW) are taking to bring these concerns to regulatory groups.
Dr. Steven P. Cohen, shared a critique of the recommendations at the session held Saturday, November 22nd, explaining that although these treatments may not conclusively provide long-term benefit for all patients, they may provide enough short-term benefit to get a patient back to exercising after surgery or other deconditioning injury. He also emphasized that epidural injections are a delivery system, not a treatment within themselves, making the recommendations misleading at best. Injections are not just done for treatment purposes; they also have diagnostic and prognostic value, as well as serving a role in facilitating other therapies.
The AHRQ study was based on a review of evidence prepared by researchers from the Pacific Northwest Evidence-Based Center, led by Director Roger Chou, MD, FACP, a professor of Medicine, Medical Informatics, and Clinical Epidemiology at the Oregon Health and Sciences University. The review of evidence looked at studies involving epidural, facet joint, and sacroiliac joint corticosteroid injections and medial branch blocks versus epidural nonsterioid injection, nonepidural injection, no injection, surgery, and nonsurgical therapies. The authors also looked at patient characteristics that might predict responsiveness, comparisons to control groups, and harms. A total of 600 articles were initially identified, and 200 of those were included in the review. In the end, the majority of studies were of epidural steroid injections, with fewer studies involving facet joint injections and only one study involving sacroiliac joint injections. The conclusions of the study indicated insufficient or low-level evidence to recommend steroid injections for long-term benefit in the treatment of facet joint and sacroiliac joint pain. However, the studies did not find that these injections were harmful.
Kevin Vorenkamp, MD, presented a review of correspondence between the MPW and the FDA regarding the report and subsequent decision-making which could prevent patients from receiving potentially helpful treatments. The MPW has provided two responses to the FDA but still has not received any assurance that the report will be reevaluated.In a subsequent Q&A session, ASRA President Oscar de Leon-Casasola, MD, said that he believes the Centers for Medicaid and Medicare have a responsibility to put a stop to the “willy nilly procedures” being performed by non-trained personnel, putting an undue burden on payors. However, in attempting to better manage these costs, the report has put these treatments in jeopardy for patients who actually can benefit from receiving them from qualified providers.
At this time, there are no guidelines regarding who should perform epidural injections; however, it is the opinion of ASRA, consistent with that of the American Society of Anesthesiologists (ASA), that these procedures should be performed by appropriately trained physicians.
Drs. Mark Wallace, Stephen P. Cohen, Kevin Vorenkamp, and Oscar de Leon-Casasola are available for phone interviews by contacting Anne Snively at 724-759-1520.
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