The Myth of 3 Injections

I have been practicing pain medicine for over twenty years. When I think of the one thing that is the biggest myth in all of pain medicine, it is the myth of 3 injections. Patients started coming to me and saying, “Doc, all my friends are telling me that I need three epidural steroids to get better. They all got 3, how come I only got 2?”

I would ask them “Well, is your pain gone and do you feel better?” All of them would say “Well, yes.” Then I would ask them if any of their friends’ doctors are pain medicine specialists and all of them would say that they were just friends.

So I would explain to them, and here to readers, that there is no science or any studies that ever said that a person needs 3 epidural steroid injections to get better.

The myth goes back 30 or so years when epidural steroid injections were just a relatively new procedure to treat herniated disc disease and back pain. At a conference, the presenter at one meeting asked the pain doctors in the audience how many injections on average they perform on each patient. With a show of hands, the majority said three. This hand raising event has transformed itself by urban legend into a “reality” in the minds of regular people and in the insurance company’s minds.

This has happened despite the fact that all major organizations in pain like ISIS – the International Spinal Injection Society- have never endorsed this concept at all.

In reality, the correct treatment is to do one injection. If it works, then that is enough. Sometimes, in 2 weeks, a second injection, or even a third on some occasions, may be necessary for full nerve healing after an injury; but sometimes even one injection cures the pain and that is enough. So if a pain doctor says you need 3 injections – even though after 1 or 2 you are fine – then just let them know that you have had enough steroids for now and will come back if your pain returns.

Some doctors even book 3 injections before re-evaluating the patient- and that is not necessary. In this situation, tell your doctor that you will do 1 and then come back in and see if you need another. Limit the steroid injection and amount of steroids — you may need them again in the future; and only treat as needed — there never has been, or will be, a magic number of 3.

So let’s all try and just get the treatment we need and not support urban legends or myths.

P.S. The rule of 3 has grown in some people’s minds to include all types of injections – this will be the topic of the next blog. For now, stick to only the minimal number of injections needed and start a new legend. Get as few injections as possible to get the result needed.

The Office of Dr. Harvey Finkelstein