Injections for back pain becoming more frequent among general physicians

Sep 14 2011
A growing number of non-specialists are treating patients with injections for back pain due to damaged facet joints.

Insurers are making payments to general practitioners that are comparable to amounts paid to interventional pain physicians for the same treatment, as reported in late August by Becker's Orthopedic Spine & Pain Management.

Facet joints are small junctures that connect any vertebrae bones and allow the spine flexibility and movement. They are also located close to nerves in the spinal column, according to the American Academy of Orthopaedic Surgeons (AAOS). These structures can be damaged from injury or diseases such as arthritis. To treat facet joint pain, medication can be injected directly into the affected region with the guidance fluoroscopy, which uses special dyes and x-rays.

This treatment is often used in combination with exercises and stretches to keep the spine flexible and mobile. If done improperly, the intervention can lead to complications such as infection, muscle weakness, increased pain or paralysis, according to AAOS.

Between 2002 and 2006, the number of facet joint injections performed by general practitioners shot up by more than 270 percent. In the same time period, Medicare payments for these procedures increased 123 percent, from $229 million to $511 million. These numbers may be growing because the amount of people who complain about chronic low back pain increases by more than 11 percent a year, according to a study published in Biomed Central Health Services Research.

One concern from these emerging trends is that some offices do not use fluoroscopy to guide their procedures. Also, diagnoses from non-specialists may be inaccurate.

In 2008, the Office of the Inspector General concluded that $96 million was wasted on improper procedures by the end of 2006. They recommended stronger policies to prevent incorrect payments and appropriate action to monitor medically unnecessary services related to facet joint injections.