020 8393 3038

Cheyham Lodge, 11 Cheam Road, Ewell Village, Epsom, Surrey KT17 1ST

Epidural injections for sciatica; Research findings.

Below is a summary of an article questioning the benefit of epidural injections for radiculopathy (common known as sciatica) a relatively frequent condition consisting of pain, & often changes in sensation such as tingling or numbness, in the leg(s) associated with certain back conditions.

Questionable Benefit

A recent systematic review and meta-analysis of published studies concludes that Epidural corticosteroid injections offer limited short-term relief for radiculopathy and no clear benefit for spinal stenosis (a problem involving narrowing of the canal containing the spinal nerves- usually due to wear & tear of the spine),

Steroid injections are commonly and increasingly used to treat radiculopathy and spinal stenosis, despite conflicting evidence of efficacy.

“As epidural injections are just one of many treatments available for the low back pain conditions that were the focus of the article (radiculopathy and spinal stenosis), it’s important to understand their benefits and harms to help clinicians and patients make informed choices,” first author Roger Chou, MD, from Oregon Health & Science University, Portland, told Medscape Medical News.

Their results were published online August 24 in Annals of Internal Medicine.

In this study, the researchers synthesized data from 30 placebo-controlled studies comparing epidural corticosteroid injections with placebo interventions for radiculopathy and 8 studies comparing corticosteroid injections with placebo for spinal stenosis.

“For radiculopathy (often presumed to be due to a herniated disc), epidural corticosteroid injections are associated with small beneficial effects compared with placebo interventions on pain and function that are present in the first 2 weeks but are then no longer present at longer-term follow-up,” Dr Chou said.

Spinal injections were associated with reduced risk for surgery in the short term, but these effects also dissipated with longer follow-up.

“For spinal stenosis, epidural corticosteroid injections were no better than placebo injections on any outcome,” Dr Chou said.

Serious adverse events appeared to be rare but reporting of adverse events in the studies was suboptimal, the researchers note.

It’s important for patients to have this information so that they can make informed choices, as the benefits of these procedures are perceived to be greater than they are,” Dr Chou said.

The authors note that their analysis was limited to English-language studies; some meta-analyses were based on small numbers of trials (particularly for spinal stenosis) and most trials had methodologic “shortcomings.”

Richard Katesmark comments;

I’m not surprised to find that in general many studies suggest corticosteroids do not offer a long-term or sustained relief for low back pain when compared to placebo or other treatment modalities as most of the people I see with radiculopathy will get better with a combination of osteopathic treatment, rest & specific exercises.

However in my experience there are a small number of patients who do undoubtedly benefit from injections described above.

The key is to identify the sub-group of patients who are the most likely to be helped by this approach. This takes clinical experience & careful examination.

Specifically; In patients with severe to moderate radicular pain with correlating MRI scan results who have failed to respond to rest and previous treatment Epidural steroids can be a component of a multifactorial approach to treatment that may include osteopathic manipulative therapy, certain medications, strength training, exercise, weight loss, and many other techniques.

The short-term pain relief provided by epidural steroids allows the patient to take part in the other aspects of the treatment regimen, thus making a successful pain relief outcome more likely.