Graduation Year

2008

Document Type

Thesis

Degree

M.S.P.H.

Degree Granting Department

Environmental and Occupational Health

Major Professor

Stuart M. Brooks, M.D.

Keywords

Pain scale, Narcotic dose, Herniated nucleus pulposus, New guinea syndrome, Disability

Abstract

No conclusive evidence exists to determine that epidural steroid injections (ESIs) provide lasting improvements in chronic pain due to herniated discs, in the Workers' Compensation population. Recently, an article by Armon et.al was published by the American Academy of Neurology, which stated that the routine use of ESIs is not recommended and that further studies are needed to elucidate this controversy (Armon, Argoff, Samuels, & Backonja, 2007). In 1998, back pain in the United States was estimated to have incurred total health-care expenditures of $90.7 billion. Medicare part B. claims in 1999 for 40.4 million individuals amounted to $49.9 million for lumbar epidural steroid injections alone. The practice of evidence based medicine will reduce health care costs and discomforts of the procedure. The objective of this study was to determine if ESIs will result in reduction of pain levels and pain medications used, and to determine the cost of treatment.

In this retrospective cohort chart review study, where claimants served as their own controls, pain levels and medications used, were retrospectively assessed using documented pain scores based on the numerical pain scale, and medications prescribed, respectively. Further correlations were made with clinical and MRI findings. Costs were derived based on the amount billed by the provider to the insurance company. A randomized list of 600 charts from the insurance company's database was obtained and 120 were selected for study based on criteria. Data abstracted included gender, weight, date of injury, clinical symptoms, MRI findings, pain scores before and after ESIs, medications used before and after ESIs , date of ESIs, total amount billed for the ESIs, surgery, and total cost of the injury to date of data abstraction. The mean pain score before was 6.97 and 7.51 after ESIs The mean number of pain medication groups before was 2.41 and 3.10 after ESIs.

The mean morphine equivalent dose before was 10.50mg and 22.07mg after ESIs. There was no significant correlation between amount billed for ESI and pain level. It was concluded that use of ESIs in the treatment chronic radicular pain does not reduce workers' pain levels, amount of pain medications, or narcotic consumed. These measures of discomfort remained the same, or were increased regardless of money spent.

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