Ethical reasoning also considers existing professional guidelines. Although the ACR does not currently have guidelines for the treatment of low back pain, the American Academy of Neurology (AAN) does. The AAN notes that epidural steroid injections may provide temporary relief in back pain associated with radiculopathy. It would be reasonable to share this information with the patient.
Finally, the patient’s wishes must be considered. A fully informed patient can participate in a shared decision-making process to select the best option for him or her. Of course, such discussions take more time, yet they remain a central responsibility to the provision of optimal medical care for our patients.
Recommendation: Good medical practice must strive to educate patients concerning treatment options and the complexity of the pain itself.
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Dr. MacKenzie is associate professor of clinical medicine and public health at Weill Cornell Medical College, Hospital for Special Surgery in New York. Dr. Kitsis is director of Bioethics Education and a member of the rheumatology division at Albert Einstein College Medicine in the Bronx, N.Y. Dr. Meltzer is assistant professor of medicine at Thomas Jefferson University in Philadelphia.
References
- Chibnall JT, Tait RC, Andresen EM, Hadler NM. Clinical and social predictors of application for social security disability insurance by workers’ compensation claimants with low back pain. J Occup Environ Med. 2006;48:733-740.
- Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ. 2006;332:1430-1434.
- Nahm FS, Lee CJ, Lee SH, et al. Risk of intravascular injection in transforaminal epidural injections. Anaesthesia. 2010 Jul 13. [Epub ahead of print]
