How Common Is This Procedure?

Based on the current data, it appears that the annual increase in the population with chronic low back pain is 11.6%, and the increase in epidural visits was 11.4% from 2002 to 2006. Over the years there has been significant growth in interventional pain management, due to improved education and more IPM practitioners. 

Interventional techniques for the treatment of spinal pain are commonly used. Epidural injections and facet joint interventions are the two most commonly utilized procedures in interventional pain management.

Epidural injections increased significantly in Medicare beneficiaries from 1997 to 2006. Patients receiving epidurals increased by 106.3%; visits per 100,000 populations increased 102.7%.

Expenditures in managing spinal pain are substantial and increasing. However, the treatment of spinal pain is controversial, as evidenced by wide variability in the treatment methods used and alleged lack of evidence of efficacy.

Of important note, it has been demonstrated that there are significant geographic variations in the administration of epidural steroid injections in Medicare patients - with southern states tending to have the highest procedure rates, and northeastern states the lowest procedure rates. 

Consumer Caution

Personnel at The American Society of Interventional Pain Physicians (ASIPP) was interviewed by Marketdata and provided excellent insight into the status of pain management, regarding anesthesiologists.  Personnel claim that the field of pain management is indeed in turmoil and there is a paradigm shift taking place in pain management – more procedures are being performed.  It estimated that there are 7,000 to 10,000 physicians in the country currently practicing, not all of whom are anesthesiologists (only 3,900 are anesthesiologists).. Apparently, one can make a lot of money just doing injections in an office setting and there is no need for credentials. A doctor can literally take a weekend course to learn how. As a result, such MDs as orthopedists, family practitioners, general practitioners, pediatricians, and physiatrists are all involved. Unfortunately, this group of newcomers is associated with a high rate of billing errors and improper treatment.

So, if you want to get an injection done properly, you are probably better off going to a pain specialist, not a generalist.

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Based on Marketdata's 2003 study of pain management programs, 82% of all pain treatment practitioners used nerve blocks to treat chronic pain. This share was exceeded only by trigger point injections at 84%. And, 100% of anesthesiologists use nerve blocks.

It's ironic that nerve blocks  are also the second most often denied procedure by insurers.

Some anesthesiologists spend little time on patient evaluations, concentrating mostly on performing nerve block procedures.  At the high-volume end, the doctor may see 15-20 patients a day, several times per week.  At the low-volume end of the scale, an anesthesiologist may see 3-5 patients a day.  Most workweeks average 2-5 days. A typical epidural nerve block for lower back pain costs $350-400 for several visits. Costs vary, depending on the site of the block.  Some patients only come for 3-4 visits, while others may be treated for 1-2 years, and some do not respond to treatment at all.

The Cost

In 2003, The average cost derived from respondents PER VISIT by anesthesiologists was $378.77.  At an average of 9.7 visits during a patient’s treatment, this came to a total treatment tab of $3,674. By comparison, the average cost in 2001 was $4,504.

This is about 25% lower than the total pain programs group average, and is about 34% lower than the cost of multidisciplinary pain management programs ($5,547 in 2003).  The per-visit charge for multidisciplinary programs, based on Marketdata's last survey ($571.94) is 50% higher than treatment by an anesthesiologist.

How Nerve Blocks Are Done

Types of Nerve Blocks

There are three main types of nerve blocks:

1. ·     Peripheral. For localized pain, an anesthetic is injected around a nerve that's away from the spine, such as in an ankle. The result is reduced feeling and less pain in that area.

2. ·     Spinal. For pain that affects a broader area, such as your lower back or a leg, an anesthetic is injected in or near the spinal column. An injection directly into the spinal fluid is called an intrathecal injection. This type of injection is often used during surgery on the abdomen or legs.

3. ·     If the injection isn't into the spinal fluid, it's called an epidural injection. Epidurals are often used to relieve the pain of childbirth and sometimes to relieve some types of back pain, such as sciatica.

Various areas of pain require different nerve block types. Below are a few of the available nerve blocks, followed in parentheses by some of the parts of the body for which they are used.

• Trigeminal nerve blocks (face)

• Ophthalmic nerve block (eyelids and scalp)

• Supraorbital nerve block (forehead)

• Maxillary nerve block (upper jaw)

• Sphenopalatine nerve block (nose and palate)

• Cervical epidural, thoracic epidural, and lumbar epidural block (neck and back)

• Cervical plexus block and cervical paravertebral block (shoulder and upper neck)

• Brachial plexus block, elbow block, and wrist block (shoulder/arm/hand, elbow, and wrist)

• Subarachnoid block and celiac plexus block (abdomen and pelvis)

Potential Side Effects and Risks of Nerve Blocks

• Elevated blood sugars

• rash

• Itching

• Weight gain

• Extra energy

• Soreness at the site of injection

• Bleeding

• Death (in rare cases)