Special thanks to star physical therapist Brace Hayden, DPT, CSCS of Alpine Physical Therapy for providing this write up on a recent article from Spine.
Low back pain with radiating leg pain or sciatica is a common problem in the United States and often highly expensive to manage. Conservative treatment by general medical practitioners, or the non-surgical approach of patient education, pain medicine and rehabilitation cost upwards of $55,000 per case, per five years. One in ten cases of low back pain have an irritated nerve root or radiculopathy that radiate pain down the leg past the knee. This type of back pain with sciatic leg complications from a bulging disc defined in this paper as “lumbosacral radicular syndrome”, often takes a large financial toll, as there is lost time from work and expensive medical costs.
Shortening the painful, acute phase of lumbosacral radicular syndrome using a steroid shot to the level of the bulging disc is a widely-accepted and often effective treatment. Dr. Spijker-Huiges and her team of Dutch researchers assessed the costs of possibly shortening the duration of this injury and the medical costs to provide it. The study used a randomized control design where half of the 73 subjects received “care as usual” treatment from their provider and the other half were given a steroid shot to the back at the injured level and the usual medical care. The Dutch providers used the nationally recommended guideline for back pain treatment that includes pain medication, recommendations to maintain normal daily activities as much as they are able, and referrals for other rehabilitative treatments as necessary.
This study found small, but significant differences in many of the research variables they measured over the course of a year in the subjects in both the control and steroid intervention group. Interesting findings turned up less expensive and more cost-effective treatments in the steroid intervention group. The addition of a steroid shot cost $259 or 191 Euros, but saved the individual the costs of lost work wages, increased total medication use, and increased time in physical therapy and other alternative therapies. Intervening with a steroid shot during the acute phase also had a small, but clinically measurable effect on reducing the individual’s initial pain and disability scores.
The authors noted that careful selection of patients during the acute phase (less than six weeks in duration) of this low back injury is important, as longer durations of radiating back pain do not respond as well. They concluded that implementing steroid injections is a win-win medical treatment for this disabling back injury with few negative side effects and many cost-saving benefits to society over the typical medical care. The patient’s pain and return to work time are also improved; thus, their productivity and income are increased.
Spijker-Huiges A., MD, et al. Costs and Cost-effectiveness of Epidural Steroids for Acute Lumbosacral Radicular Syndrome in General Practice. An Economic Evaluation Alongside a Pragmatic Randomized Control Trial. In SPINE. Nov. 2014. Vol. 39, Pp. 2007 – 2012.
For more information on this topic, view our clinical module on steroid injections for back and sciatic pain by clicking here.
Brent Dodge is the founding owner of Alpine Physical Therapy and is a board certified orthopedic specialist. He holds additional certifications in Functional Dry Needling, Manual Physical Therapy, and Strength and Conditioning.
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