ASA recommends the Oregon Health Authority’s (OHA) Health Evidence Review Committee (HERC) reconsider its initial ruling that eliminates coverage for epidural steroid spinal injections for patients suffering from chronic back pain in the state’s health programs, including the Oregon Health Plan, the state Medicaid program. The OHA will take up the issue at its Evidence-based Guidelines Subcommittee meeting tomorrow, April 6, 2 – 5 p.m.
“It is estimated that 80 percent of people experience back pain at some time in their life and more than 100 million Americans suffer from the condition,” said Asokumar Buvanendran, M.D., chair, ASA Committee on Pain Medicine. “As a physician anesthesiologist with a special focus on pain medicine, I feel very strongly that the review committee reverse its initial ruling, so all patients in Oregon can have the hope of a future without debilitating pain.”
Patients suffering from chronic back pain sometimes have no treatment options other than spinal injections. Frequently, they have worked with their physician anesthesiologist who has developed a pain plan that has exhausted more conservative therapies such as lifestyle changes, medications and physical therapy. Other alternatives, such as non-steroidal anti-inflammatory medications (NSAIDs) and opioids have a potential for serious adverse effects such as gastrointestinal bleeding, abuse, addiction and death.
Critics of epidural steroid spinal injections note that these injections have limited effectiveness and pain relief wears off quickly. Dr. Buvanendran counters that the same can be said for most therapies for back pain, including surgery, which most studies show does not provide pain relief for longer than two years.
Evidence exists that shows epidural steroid spinal injections are effective in well-selected patients, based on tens of millions of injections, clinical trials and observational studies. Even “negative” studies show at least a short-term benefit lasting up to six weeks from a single injection. A wealth of literature suggests that performing multiple injections on an “as needed” basis enables patients to function well, including returning to work, over a long period of time.
“It’s unreasonable to remove a minimal risk, beneficial treatment when there are no clear-cut effective alternatives,” said Dr. Buvandendran. “Returning epidural steroid spinal injection coverage for all Oregon patients, not just those who can afford them, will provide significant pain relief, improved function and quality of life, while reducing the need for surgery or opioids, which is particularly important in light of the national opioid abuse epidemic.”
THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS®
Founded in 1905, the American Society of Anesthesiologists (ASA®) is an educational, research and scientific society with more than 52,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.
For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org