Overuse of steroids

As a general internist and primary care provider, I have to say that it is well-known by PCPs and specialists that epidural injections are not effective for chronic low back pain. In 15 yrs of practice I can’t recall a pain specialist recommending ESI for back pain alone. Epidurals are often quite effective for radicular pain to the lower extremities. Sometimes the pain never returns. Other times it lasts only months but allows a patient to avoid surgery or high doses of pain medications. If partial or temporary effect is achieved, then I see them offer a second injection which is often more effective or longer lasting. I don’t recall ever seeing an interventional pain specialist give 3 injections when the first 2 were ineffective. I have seen many patients benefit. I’ve seen a much smaller fraction get no response. And though I know there are rare potential adverse effects, none of my patients have suffered any other than temporary soreness at the injection site or temporary elevation in blood glucose levels in diabetics (which can be easily managed).
Medicine is the application of current scientific knowledge to unique individuals. As such, it is imperfect but it is introspective and always adapting, growing and learning. It is unfortunate that investigative journalism, while serving an important function, has to sensationalize and divide to get the attention amidst all the other clamor. The mistrust that is engendered towards physicians in general is not constructive.
An example is those books titled “What your doctor doesn’t want you to know about… ” Really?
Please. We are all patients. Our loved ones are patients, too.

Remember, nothing is alleged to--or can have--happened to all of MLB over some one or two seasons: the claim is that PEDs were being used at a slowly but steadily increasing rate (and thus "distorting records") from very roughly 1980 through the present. Were that so, or anything like it, we would expect to see a clear long-term uptrend during this period. But we don't: we see a nearly flat line that, if anything, slopes slightly down. The "boost" just isn't there. But that doesn't seem to stop anyone from talking about it.

Overuse of steroids

overuse of steroids


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