1. 2022;25;E857-E862Variations in Epidural Steroid Injection Practice Patterns by Pain Medicine Physicians in the United States
   Cross-sectional Survey
   Nishan Bingham, MD, Raymon Dhall, MD, Michael Montuori, MD, Kristoffer Padjen, MD, PhD, Christopher Gharibo, MD, and Lisa Doan, MD.

BACKGROUND: Epidural steroid injections (ESI) are one of the most commonly performed pain procedures; however, there has been variation in techniques and approaches amongst pain physicians in the United States. The formation of a multidisciplinary working group was made with considerations to help guide ESI practice.

OBJECTIVE: Pain medicine physicians in the United States were surveyed in order to provide an update on current practices for both transforaminal and interlaminar ESI.      

STUDY DESIGN and SETTING: This was a cross-sectional survey of pain medicine physicians in the United States.

METHODS: This study was approved by the institutional review board of our institution. Based on the American Society of Interventional Pain Physicians membership database, an email list was generated, and a web-based survey was sent to interventional pain physicians at academic centers, private practices, government hospitals, and community settings across the United States. Cervical, lumbar, and caudal ESI sections were divided into questions regarding preferences for fluoroscopic views, injectates, and techniques.

RESULTS: A total of 261 responses were analyzed. All but one used fluoroscopy for lumbar ESI. There were variations in methods to detect intravascular uptake, choice of injectate, and the use of particulate steroids for lumbar transforaminal epidural steroid injection (TFESI).

LIMITATIONS: The response rate is a limitation, and thus the results may not be representative of all pain medicine physicians in the United States.

CONCLUSIONS: Since the 2015 multidisciplinary pain workgroup recommendations were made for ESI, there appears to be a trend towards following these guidelines compared to prior surveys looking at ESI practices. However, our survey shows there continues to be variations in ESI practice that deviates from these guidelines.

KEY WORDS: Epidural steroid injections, transforaminal epidural injection, interlaminar epidural injection, interventional pain, survey, lower back pain, neck pain