Dad is a veteran of the Vietnam War. He receives excellent services from the VA in our area. In fact, we're concerned that maybe he's getting too much help. For his chronic back pain, he's on powerful pain relievers AND getting steroid injections. Is this all really needed?

Pain control for patients with chronic low back pain can be quite a challenge. The cause of the problem must be considered along with many other variables. These include the patient's age, general health condition, and medications already being taken.

If pain relievers don't help, it's natural to try something else. But your concerns are important. Without knowing your father's exact diagnosis, here's what we can offer. First, many strong pain relievers fall into the drug class of opioids. Used appropriately, opioids can be very effective. It's important to avoid dependence and addiction while managing any negative side effects.

Patient selection for the use of epidural steroid injections (ESIs) is also important. Studies show ESIs are recommended for use in patients with sciatica (back and buttock or leg pain from pressure on the sciatic nerve). Use of ESIs to treat spinal stenosis cannot be supported from studies done so far.

ESIs are considered a less expensive, less risky way to treat chronic low back pain without resorting to surgery. Even so, in the VA system, treatment isn't always driven by cost considerations. As you pointed out, this can be a problem if patients are being over treated for a problem.

If your father will give you permission to speak with the clinic staff, you might try contacting the socal worker or case manager assigned to your father's case. Present your concerns and find out more about the plan and any other options for pain management that may exist.