A National Pain Report story on a study that questioned the efficacy of epidural steroid injections (ESI) for back pain relief has drawn a strong response from a prominent Kentucky pain specialist.
Dr. James Patrick Murphy, who is Medical Director of the Murphy Pain Center in Louisville, Kentucky, is an anesthesiologist and is certified in pain medicine. He is also an Assistant Clinical Professor at the University of Louisville School of Medicine.
We asked Dr. Murphy to share his thoughts.
“Of the over 100 million Americans living with chronic pain, low back pain is the most common ailment. While low back pain can result from numerous causes (e.g., muscle spasm, ligament strain, fractures) many cases of low back pain ultimately involve inflammation of a spinal nerve. When a spinal nerve is inflamed, as is commonly the case when a disk herniates, the pain usually extends from the back to the leg, and sometimes all the way to the toes. Depending on the severity of the disk herniation and inflammation, the leg can go weak or go numb or both. This miserable situation is called radiculitis.”
“Epidural steroid injections place powerful anti-inflammatory agents very close to the source of the pain. The goal of the epidural is to diminish inflammation, improve function, and promote healing. As a pain specialist, I have personally witnessed the tremendous benefit these epidurals offer patients. I have also witnessed the unfortunate ones for whom this procedure does not help. One of the themes to my “informed consent” spiel is that an epidural will not be a cure. Your body actually has to cure itself by repairing the herniated disk and turning off your internal inflammation switch. The epidural’s role is to jump-start the process and keep you functioning and less painful during this time of healing”
“Metaphorically speaking, epidurals might be to the pain specialist what the nine-iron club is to the golfer -an important tool for certain situations, not be used in every situation, and best used in conjunction with other tools as part of an overall “game plan.” The most important factor is deciding whether or not, for you, the epidural’s benefits outweigh the risks. A patient considering an epidural needs to discuss these risks along with the potential benefits and available treatment alternatives with the clinician. Epidurals are not appropriate for every patient with low back pain, but in properly selected patients the evidence, along with my personal experience, is that epidurals can be very effective in allowing a person suffering from spinal inflammation to function and participate in programs that promote healing.”
Dr. Murphy also cited a paper by Dr. Steven Cohen that is, what Dr. Murphy calls, a comprehensive review of the data and expert opinions: Epidural Steroids A Comprehensive, Evidence-Based Review, by Steven P. Cohen, MD, et al. To read it, click here.
One of his patients has submitted a “My Story” talking about her experiences with ESIs which we will publish at a future date.