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Epidural steroid injections carry risks, but offer advantages over opioids


"Whenever there's introduction of a needle into the body, we think about potential safety concerns,” said Dr. Robert Hall, Westerville, Ohio-based medical director at pharmacy benefit manager Helios.

But compared with other surgical procedures and sometimes opioid use, epidural steroid injections are in the “spectrum of conservative care,” Dr. Hall said.

It depends on the person, but if an injured worker is unresponsive to truly conservative treatments, such as physical therapy, nonsteroidal anti-inflammatory drugs and heat, Dr. Hall said an epidural steroid injection may be preferable to opioids, which are absorbed through the gastrointestinal tract.

That preference translates on the cost front, as well, said Dr. Marcos Iglesias, vice president and medical director at The Hartford Financial Services Group Inc. in Hartford, Connecticut.

“Opioids are rarely used for a very short period of time, and claims that are given opioids tend to be much more expensive,” Dr. Iglesias said. “On the other hand, an epidural steroid injection is typically a fairly straightforward outpatient procedure ... in the neighborhood of several hundred dollars.”

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