In my London clinic I work alongside a very well known Spinal Surgeon. I asked him about his continued use of facet joint infiltrations (where steroid and local anesthetic is injected into the spinal joints) despite the lack evidence for efficacy and the NICE guidelines recommending against it’s use.
For those who are unaware, the NICE guidelines of May 2009 recommended against the use of these injections. This caused an outcry from in particular pain specialists, who use these all the time for the treatment for some types of low back pain and who feel they are effective.
His answer was interesting. He sees patients every week who he, through his experience, identifies as those who he thinks will improve with these injections. He explains to the patients the evidence, risks and benefits and why he thinks in their case it is the right treatment to administer. Patients rightly trust this very experienced and excellent surgeon and give him consent to go ahead with a treatment he recommends.
This type of encounter often occurs in a healthcare setting, and demonstrates that although evidence must guide our thinking, there may be times where experience and patient choice can outweigh that.
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at 5:04 pm