Why do pain management doctors always want to repeat procedures such as injections into the spine (epidurals) or surgeries which have been unsuccessful?

That's the Standard: I personally don't agree with this philosophy. Repeating the same failed intervention with an expectation of a different result is crazy, especially before simpler interventions such as trigger point injections, therapeutic exercise and pt have not been tried. We have a lot of docs trained to identify pain generators when the patient might have responded to simpler initial treatment.

Not a cure: Epidural inj is relieving pain supposedly by reducing swelling and other mechanism. In my practice I do not recommend to have more than 3 injections. Epidural inj in my opinion is generally temporary relief there are of course some exception.

Repetition: Its just like taking the medication. You get the response if you keep taking em.Purpose of injection is not to 'fix the problem' but to have pain under control temporarily so that the meds can work better. Think of it as going on a diet. It will cos wt loss for few months but when you stop it, wt will go right back up!

Why repeat ?: Epidural injection for folks who are not good surgical candidates may be all the relief they get. May not be a cure, but the body god gave us sure is and (especially in disc bulge/protrusion/herniation) if we can limit the pain to "livable" then we can give the body time to "seal over"/"scar over" the offended area. The body has the ability to cure itself of all cureable ills. We buy it time.

Furthermore: There can be significant variability in how a procedure is performed. Unless I have an op report or a copy of the intraop xray i generally don't assume that the best technique was used and will repeat the injection myself. Unless i know the other md of course. Also, there are a lot of spine injections that target different things. They are not all the same and pts generally don't know for sure.

Also: I should clarify that if i know the procedure was done correctly and didn't help, there is no reason to repeat unless something has changed (new symptoms, examination findings, trauma, MRI changes etc).