scholarly journals Utilization and Growth Patterns of Sacroiliac Joint Injections from 2000 to 2011 in the Medicare Population

2013 ◽  
Vol 4;16 (4;7) ◽  
pp. E379-E390 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Management ◽  
Sacroiliac Joint ◽  
Facet Joint ◽  
Growth Patterns ◽  
Low Back ◽  
Medicare Beneficiaries ◽  
Medicare Population ◽  
Joint Injections

Background: The high prevalence of persistent low back pain and growing number of diagnostic and therapeutic modalities employed to manage chronic low back pain and the subsequent impact on society and the economy continue to hold sway over health care policy. Among the multiple causes responsible for chronic low back pain, the contributions of the sacroiliac joint have been a subject of debate albeit a paucity of research. At present, there are no definitive conservative, interventional or surgical management options for managing sacroiliac joint pain. It has been shown that the increases were highest for facet joint interventions and sacroiliac joint blocks with an increase of 310% per 100,000 Medicare beneficiaries from 2000 to 2011. There has not been a systematic assessment of the utilization and growth patterns of sacroiliac joint injections. Study Design: Analysis of the growth patterns of sacroiliac joint injections in Medicare beneficiaries from 2000 to 2011. Objectives: To evaluate the utilization and growth patterns of sacroiliac joint injections. Methods: This assessment was performed utilizing Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary (PSPS) Master data from 2000 to 2011. Results: The findings of this assessment in Medicare beneficiaries from 2000 to 2011 showed a 331% increase per 100,000 Medicare beneficiaries with an annual increase of 14.2%, compared to an increase in the Medicare population of 23% or annual increase of 1.9%. The number of procedures increased from 49,554 in 2000 to 252,654 in 2011, or a rate of 125 to 539 per 100,000 Medicare beneficiaries. Among the various specialists performing sacroiliac joint injections, physicians specializing in physical medicine and rehabilitation have shown the most increase, followed by neurology with 1,568% and 698%, even though many physicians from both specialties have been enrolling in interventional pain management and pain management. Even though the numbers were small for nonphysician providers including certified registered nurse anesthetists, nurse practitioners, and physician assistants, these numbers increased substantially at a rate of 4,526% per 100,000 Medicare beneficiaries with 21 procedures performed in 2000 increasing to 4,953 procedures in 2011. The, majority of sacroiliac joint injections were performed in an office setting. The utilization of sacroiliac joint injections by state from 2008 to 2010 showed increases of more than 20% in New Hampshire, Alabama, Minnesota, Vermont, Oregon, Utah, Massachusetts, Kansas, and Maine. Similarly, some states showed significant decreases of 20% or more, including Oklahoma, Louisiana, Maryland, Arkansas, New York, and Hawaii. Overall, there was a 1% increase per 100,000 Medicare population from 2008 to 2010. However, 2011 showed significant increases from 2010. Limitations: The limitations of this study included a lack of inclusion of Medicare participants in Medicare Advantage plans, the availability of an identifiable code for only sacroiliac joint injections, and the possibility that state claims data may include claims from other states. . Conclusions: This study illustrates the explosive growth of sacroiliac joint injections even more than facet joint interventions. Furthermore, certain groups of providers showed substantial increases. Overall, increases from 2008 to 2010 were nominal with 1%, but some states showed over 20% increases whereas some others showed over 20% decreases. Key words: Chronic spinal pain, low back pain, sacroiliac joint arthritis, interventional techniques, interventional pain management, sacroiliac joint injections

scholarly journals Utilization Patterns of Sacroiliac Joint Injections from 2000 to 2018 in Fee-for-Service Medicare Population

2020 ◽  
Vol 5;23 (9;5) ◽  
pp. 439-450
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Sacroiliac Joint ◽  
Low Back ◽  
Annual Increase ◽  
Interventional Techniques ◽  
Medicare Population ◽  
Radiofrequency Neurotomy ◽  
Utilization Patterns ◽  
Joint Injections

Background: Sacroiliac joint is one of the proven causes of low back and lower extremity pain. Prevalence estimates of sacroiliac joint pain range from 10% to 25% in patients with persistent axial low back pain without disc herniation, discogenic pain, or radiculitis based on multiple diagnostic studies and systematic reviews. Over the years, utilization patterns of sacroiliac joint injections have been increasing in comparison to other interventional techniques. Further, the development of new current procedural terminology (CPT) codes and coverage policies for sacroiliac joint nerve blocks, sacroiliac joint radiofrequency neurotomy, and evolving evidence for sacroiliac joint fusion will further increase the utilization patterns. Study Design: Analysis of growth patterns of sacroiliac joint injections from 2000 to 2018 with comparative analysis of 2000 to 2009 and 2009 to 2018. Objectives: To assess utilization patterns of sacroiliac joint injections from 2000 to 2018. Methods The Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary (PSPS) Master dataset was utilized in this analysis. Results: The results of the evaluation from 2009 to 2018 showed an increase of 11.3% and an annual increase of 1.2% per 100,000 Medicare population. However, from 2000 to 2009, an increase of 299.8% from 2000 to 2009 with an annual increase of 16.6% per 100,000 Medicare population. Limitations: The limitations of this study included a lack of data on the new sacroiliac joint nerve block and radiofrequency neurotomy codes. Further, this data did not include utilization patterns of sacroiliac joint fusions. In addition, Medicare Advantage patients were not included, which constitute approximately 30% of overall Medicare population. Further, there is also a possibility that state claims data may include claims from other states. As with all claims-based data analyses, this study is retrospective and thus potentially limited by bias. Finally, patients who are self or commercially insured are not part of the dataset. Conclusions: This study shows increases in utilization patterns of sacroiliac joint injections; however, at a significantly lower rate with an annual increase of 16.6% prior to 2009 and only 1.2% from 2009 to 2018 per 100,000 Medicare beneficiaries Key words: Chronic spinal pain, low back pain, sacroiliac joint arthritis, interventional techniques, sacroiliac joint injections

scholarly journals Do Regenerative Medicine Therapies Provide Long-Term Relief in Chronic Low Back Pain: A Systematic Review and Metaanalysis

2018 ◽  
Vol 1 (21;1) ◽  
pp. 515-540 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Sacroiliac Joint ◽  
Facet Joint ◽  
Low Back ◽  
Lumbar Facet Joint ◽  
Level I ◽  
Lumbar Facet ◽  
Joint Injections

Background: Several cell-based therapies have been proposed in recent years the management of low back pain, including the injection of medicinal signaling cells or mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP). However, there is only emerging clinical evidence to support their use at this time. Purpose: To assess the effectiveness of MSCs or PRP injections in the treatment of low back and lower extremity pain. Study Design: A systematic review and metaanalysis of the effectiveness of PRP and MSCs injections in managing low back and lower extremity pain. Data Sources: PubMed, Cochrane Library, US National Guideline Clearinghouse, prior systematic reviews, and reference lists. The literature search was performed from 1966 through June 2018. Study Selection: Randomized trials, observational studies, and case reports of injections of biologics into the disc, epidural space, facet joints, or sacroiliac joints. Data Extraction: Data extraction and methodological quality assessment were performed utilizing Cochrane review methodologic quality assessment and Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) and Interventional Pain Management Techniques – Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM-QRBNR). The evidence was summarized utilizing principles of best evidence synthesis on a scale of 1 to 5. Data Synthesis: Twenty-one injection studies met inclusion criteria. There were 12 lumbar disc injections, 5 epidural, 3 lumbar facet joint, and 3 sacroiliac joint studies Results: Evidence synthesis based on a single-arm metaanalysis, randomized controlled trials (RCTs), and observational studies, disc injections of PRP and MSCs showed Level 3 evidence (on a scale of Level I through V). Evidence for epidural injections based on single-arm metaanalysis, a single randomized controlled trial and other available studies demonstrated Level 4 (on a scale of Level I through V) evidence. Similarly, evidence for lumbar facet joint injections and sacroiliac joint injections without metaanalysis demonstrated Level 4 evidence (on a scale of Level I through V).. Limitations: Lack of high quality RCTs. Conclusion: The findings of this systematic review and single-arm metaanalysis shows that MSCs and PRP may be effective in managing discogenic low back pain, radicular pain, facet joint pain, and sacroiliac joint pain, with variable levels of evidence in favor of these techniques. Key Words: Chronic low back pain, regenerative therapy, medicinal signaling or mesenchymal stem cells, platelet-rich plasma, disc injection, lumbar facet joint injections, sacroiliac joint injections

scholarly journals Percutaneous Adhesiolysis Procedures in the Medicare Population: Analysis of Utilization and Growth Patterns from 2000 to 2011

2014 ◽  
Vol 2;17 (2;3) ◽  
pp. E129-E139
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Facet Joint ◽  
Growth Patterns ◽  
Low Back ◽  
Medicare Beneficiaries ◽  
Interventional Techniques ◽  
Epidural Injections ◽  
Medicare Population ◽  
Utilization Patterns ◽  
Facet Joint Interventions ◽  
Joint Injections

Background: Multiple reviews have shown that interventional techniques for chronic pain have increased dramatically over the years. Of these interventional techniques, both sacroiliac joint injections and facet joint interventions showed explosive growth, followed by epidural procedures. Percutaneous adhesiolysis procedures have not been assessed for their utilization patterns separately from epidural injections. Study Design: An analysis of the utilization patterns of percutaneous adhesiolysis procedures in managing chronic low back pain in the Medicare population from 2000 to 2011. Objective: To assess the utilization and growth patterns of percutaneous adhesiolysis in managing chronic low back pain. Methods: The study was performed utilizing the Centers for Medicare and Medicaid Services (CMS) Physician Supplier Procedure Summary Master of Fee-For-Service (FFS) Data from 2000 to 2011. Results: Percutaneous adhesiolysis procedures increased 47% with an annual growth rate of 3.6% in the FFS Medicare population from 2000 to 2011. These growth rates are significantly lower than the growth rates for sacroiliac joint injections (331%), facet joint interventions (308%), and epidural injections (130%), but substantially lower than lumbar transforaminal injections (665%) and lumbar facet joint neurolysis (544%). Limitations: Study limitations include lack of inclusion of Medicare Advantage patients. In addition, the statewide data is based on claims which may include the contiguous or other states. Conclusion: Percutaneous adhesiolysis utilization increased moderately in Medicare beneficiaries from 2000 to 2011. Overall, there was an increase of 47% in the utilization of adhesiolysis procedures per 100,000 Medicare beneficiaries, with an annual geometric average increase of 3.6%. Key words: Interventional techniques, chronic spinal pain, epidural steroid injections, percutaneous adhesiolysis, post surgery syndrome, spinal stenosis

scholarly journals USAGE PATTERNS OF SACROILIAC JOINT INJECTIONS - A COMPARATIVE EVALUATION OF PRE AND POST AFFORDABLE CARE ACT IN MEDICARE POPULATION

2018 ◽  
pp. 157-166
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Affordable Care Act ◽  
Sacroiliac Joint ◽  
Low Back ◽  
Annual Increase ◽  
Interventional Techniques ◽  
Medicare Population ◽  
Utilization Patterns ◽  
Joint Injections

Background: The sacroiliac joints (SIJ) have been implicated as highly prevalent, pervasive, expensive, causes of chronic low back pain. The utilization of SIJ injections is escalating. A recent analysis demonstrated a reversal of growth of utilization patterns of interventional techniques post passage of the Affordable Care Act (ACA). Bearing that in mind, SIJ injections along with facet joint interventions seem to have increased modestly in that same period. Study Design: Analysis of growth patterns of SIJ injections from 2000 to 2016 with comparative analysis of pre- and post- ACA. Objectives: To assess utilization patterns of SIJ injections from 2000 to 2016. Methods: The Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary (PSPS) Master dataset was utilized in this analysis. Results: The results of the evaluation from 2000 to 2016 showed, 11.7% increase from 2009 to 2016, with an annual increase of 1.6% per 100,000 Medicare population compared to an increase of 299.8% from 2000 to 2009 with annual increase of 16.6%. Limitations: The limitations of this study included a lack of inclusion of Medicare Advantage patients and the possibility that state claims data may include claims from other states. As with all claims based data analyses, this study is retrospective and thus potentially limited by bias. Finally, patients who are self or commercially insured are not part of the dataset. Conclusions: Study shows dampened increase in utilization patterns of SIJ injections from 2009 to 2016 as compared with a like time period prior. Key words: Chronic spinal pain, low back pain, sacroiliac joint arthritis, interventional techniques, interventional pain management, sacroiliac joint injections

scholarly journals Facet-joint injections for non-specific low back pain: a feasibility RCT

2017 ◽  
Vol 21 (74) ◽  
pp. 1-130 ◽  
Author(s):  
Saowarat Snidvongs ◽  
Rod S Taylor ◽  
Alia Ahmad ◽  
Simon Thomson ◽  
Manohar Sharma ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Facet Joint ◽  
Intervention Group ◽  
Clinical Effectiveness ◽  
Health Care Utilisation ◽  
Low Back ◽  
Lumbar Facet Joint ◽  
Lumbar Facet ◽  
Joint Injections

BackgroundPain of lumbar facet-joint origin is a common cause of low back pain in adults and may lead to chronic pain and disability, with associated health and socioeconomic implications. The socioeconomic burden includes an inability to return to work resulting in loss of productivity in addition to direct and indirect health-care utilisation costs. Lumbar facet-joints are paired synovial joints between the superior and inferior articular processes of consecutive lumbar vertebrae and between the fifth lumbar vertebra and the sacrum. Facet-joint pain is defined as pain that arises from any structure that is part of the facet-joints, including the fibrous capsule, synovial membrane, hyaline cartilage and bone. This pain may be treated by intra-articular injections with local anaesthetic and steroid, although this treatment is not standardised. At present, there is no definitive research to support the use of targeted lumbar facet-joint injections to manage this pain. Because of the lack of high-quality, robust clinical evidence, the National Institute for Health and Care Excellence (NICE) guidelines on the management of chronic low back pain [NICE.Low Back Pain in Adults: Early Management. Clinical guideline (CG88). London: NICE; 2009] did not recommend the use of spinal injections despite their perceived potential to reduce pain intensity and improve rehabilitation, with NICE calling for further research to be undertaken. The updated guidelines [NICE.Low Back Pain and Sciatica in Over 16s: Assessment and Management. NICE guideline (NG59). London: NICE; 2016] again do not recommend the use of spinal injections.ObjectivesTo assess the feasibility of carrying out a definitive study to evaluate the clinical effectiveness and cost-effectiveness of lumbar facet-joint injections compared with a sham procedure in patients with non-specific low back pain of > 3 months’ duration.DesignBlinded parallel two-arm pilot randomised controlled trial.SettingInitially planned as a multicentre study involving three NHS trusts in the UK, recruitment took place in the pain and spinal orthopaedic clinics at Barts Health NHS Trust only.ParticipantsAdult patients referred by their GP to the specialist clinics with non-specific low back pain of at least 3 months’ duration despite NICE-recommended best non-invasive care (education and one of a physical exercise programme, acupuncture or manual therapy). Patients who had already received lumbar facet-joint injections or who had had previous back surgery were excluded.InterventionsParticipants who had a positive result following a diagnostic test (single medial branch nerve blocks) were randomised and blinded to receive either intra-articular lumbar facet-joint injections with steroids (intervention group) or a sham procedure (control group). All participants were invited to attend a group-based combined physical and psychological (CPP) programme.Main outcome measuresIn addition to the primary outcome of feasibility, questionnaires were used to assess a range of pain-related (including the Brief Pain Inventory and Short-Form McGill Pain Questionnaire version 2) and disability-related (including the EuroQol-5 Dimensions five-level version and Oswestry Low Back Pain Questionnaire) issues. Health-care utilisation and cost data were also assessed. The questionnaire visits took place at baseline and at 6 weeks, 3 months and 6 months post randomisation. The outcome assessors were blinded to the allocation groups.ResultsOf 628 participants screened for eligibility, nine were randomised to receive the study intervention (intervention group,n = 5; sham group,n = 4), six completed the CPP programme and eight completed the study.LimitationsFailure to achieve our expected recruitment targets led to early closure of the study by the funder.ConclusionsBecause of the small number of participants recruited to the study, we were unable to draw any conclusions about the clinical effectiveness or cost-effectiveness of intra-articular lumbar facet-joint injections in the management of non-specific low back pain. Although we did not achieve the target recruitment rate from the pain clinics, we demonstrated our ability to develop a robust study protocol and deliver the intended interventions safely to all nine randomised participants, thus addressing many of the feasibility objectives.Future workStronger collaborations with primary care may improve the recruitment of patients earlier in their pain trajectory who are suitable for inclusion in a future trial.Trial registrationEudraCT 2014-003187-20 and Current Controlled Trials ISRCTN12191542.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 74. See the NIHR Journals Library website for further project information.

scholarly journals Utilization of Interventional Techniques in Managing Chronic Pain in the Medicare Population: Analysis of Growth Patterns from 2000 to 2011

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. E969-E982 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Sacroiliac Joint ◽  
Facet Joint ◽  
Medicare Beneficiaries ◽  
Interventional Techniques ◽  
Geometric Average ◽  
Interventional Pain Management ◽  
Facet Joint Interventions ◽  
Joint Injections

Background: Reports from the United States Government Accountability Office (GAO), the Institute of Medicine (IOM), the Medicare Payment Advisory Commission (MedPAC), and the Office of Inspector General (OIG) continue to express significant concern with the overall fiscal sustainability of Medicare and the exponential increase in costs for chronic pain management. Study Design: The study is an analysis of the growth of interventional techniques in managing chronic pain in Medicare beneficiaries from 2000 to 2011. Objective: To evaluate the use of all interventional techniques in chronic pain management. Methods: The study was performed utilizing the Centers for Medicare and Medicaid Services (CMS) Physician Supplier Procedure Summary Master Data from 2000 to 2011. Results: Interventional techniques for chronic pain have increased dramatically from 2000 to 2011. Overall, the increase of interventional pain management (IPM) procedures from 2000 to 2011 went up 228%, with 177% per 100,000 Medicare beneficiaries. The increases were highest for facet joint interventions and sacroiliac joint blocks with a total increase of 386% and 310% per 100,000 Medicare beneficiaries, followed by 168% and 127% for epidural and adhesiolysis procedures, 150% and 111% for other types of nerve blocks and finally, 28% and 8% increases for percutaneous disc procedures. The geometric average of annual increases was 9.7% overall with 13.7% for facet joint interventions and sacroiliac joint blocks and 7.7% for epidural and adhesiolysis procedures. Limitations: The limitations of this study included a lack of inclusion of Medicare participants in Medicare Advantage plans, as well as potential documentation, coding, and billing errors. Conclusion: Interventional techniques increased significantly in Medicare beneficiaries from 2000 to 2011. Overall, there was an increase of 177% in the utilization of IPM services per 100,000 Medicare beneficiaries, with an annual geometric average increase of 9.7%. The study also showed an exponential increase in facet joint interventions and sacroiliac joint blocks. Key words: Interventional techniques, interventional pain management, facet joint injections, epidural steroid injections, sacroiliac joint injections, chronic pain, chronic spinal pain

Sacroiliac Joint Injections: Computed Tomography

2016 ◽  
Author(s):  
Mira Herman ◽  
Amaresh Vydyanathan ◽  
Allan L. Brook
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Sacroiliac Joint ◽  
Cushing Syndrome ◽  
Joint Disease ◽  
Outpatient Basis ◽  
Low Back ◽  
Limited Mobility ◽  
Si Joint ◽  
Joint Injections

Sacroiliac (SI) joint disease is a common cause of low back pain. It is not easily diagnosed by physical examination, as the joint has limited mobility and referral patterns are not sufficiently delineated from other pathological conditions implicated in low back pain. The accuracy of provocative testing of the sacroiliac joint is controversial. Many physicians use injection of the SI joint with local anesthetic and/or steroid as a diagnostic and therapeutic tool in treating SI joint–related pain. Historically, SI joint intra-articular injections have been performed without imaging guidance. Imaging-guided techniques, often using CT fluoroscopy, increase the precision of these procedures and help confirm needle placement while achieving better results and reduced complications rates. Sacroiliac joint injection is routinely performed on an outpatient basis. The patient is questioned regarding previous steroid use (oral, cutaneous, or injected) to avoid iatrogenic Cushing syndrome. Repeat injections can be administered depending on patient’s response.

Facet Joint Injections for the Management of Low Back Pain: A Clinical Review

2021 ◽  
pp. 14
Author(s):  
Aboud AlJabari
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Facet Joint ◽  
Low Back ◽  
Diagnostic Measures ◽  
Pain Characteristics ◽  
Physical Findings ◽  
Lumbar Facet ◽  
Joint Injections ◽  
Demographic Features

Introduction: Lumbar facet joints have been implicated in chronic low back pain (LBP) in up to 45% of patients with LBP. Facet joint pain (FJP) diagnosis and management are always challenging for pain physicians. FJP is not diagnosed by specific demographic features, pain characteristics, or physical findings, despite the electrodiagnostic studies and imaging modalities being available. Although comparative local anesthetics or placebo saline injections can be used, diagnostic blocks are the only reliable diagnostic measures according to the current literature. Methodology: A randomized, controlled clinical trial was conducted to evaluate the effectiveness of lumbar facet joint injections. A total of 229 participants were enrolled to receive facet injections with bupivacaine and steroid, medial branch blocks, or saline. Result: The results of this study showed that facet joint injections had little long-term therapeutic utility, but had a prognostic value compared to control injections before radiofrequency ablation. Thus, the results of this study emphasized the diagnostic value of facet joint injections. Conclusion: FJP is not diagnosed by demographic features, pain characteristics, physical findings, electrodiagnostic studies, or radiological evaluation as other types of LBP. Diagnostic blocks using comparative local anesthetic blocks or placebo injections are the only reliable diagnostic measures according to the current literature. Their validity, specificity, and sensitivity are considered reliable in the diagnosis of FJP. Facet joint-related anatomical, clinical, and technical knowledge is essential for successful pain management. Pain physicians should embrace all aspects of FJP management, from diagnosis to interventional management.

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