Spinal steroid shots may have little effect on sciatica

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Spinal steroid shots may have little effect on sciatica

By Andrew M. Seaman
NEW YORK | Mon Nov 12, 2012 5:05pm EST

(Reuters Health) – Despite the growing popularity of steroid injections to treat various kinds of back pain in recent years, a new review of past research finds the shots do little to alleviate sciatica, a common condition that causes leg and back pain.

Australian researchers found that epidural injections (into the spine) of corticosteroids had no long- or short-term effect on sciatica back pain, and such a small short-term effect on leg pain it would make no difference to the patient.

Nonetheless, the use of epidural steroid injections to treat back pain of all sorts among Medicare patients nearly doubled from 741,000 in 2000 to about 1,438,000 in 2004, according to the researchers.

For sciatica, which is thought to be caused by nerve damage, past studies have already questioned the effectiveness of spinal steroid shots.

For the back pain component of sciatica, the researchers found that the injections didn’t seem to make a difference over short or long periods of time.

When it came to leg pain, there was no difference a year or so after the injection, but there was a statistically significant six-point drop in pain scores over the short term – about 2 weeks to 3 months.

Instead of steroid injections, people suffering with sciatica should consult their doctor, but other options include simple pain relievers, such as acetaminophen, drugs that treat pain by working throughout a person’s nervous system and, as a last resort, surgery.

Not everyone agrees that steroid injections should be excluded from the hierarchy of treatments for sciatica.
“In general, I think we’ve learned over the years that the epidural injections are turning out to be less and less successful… but there are times when they should be considered,” said Dr. Kirkham B. Wood, chief of the orthopedic spine service at Boston’s Massachusetts General Hospital.

SOURCE: bit.ly/SQRXAa Annals of Internal Medicine, online November 12, 2012.