Injections a waste of time for sciatica

Epidural corticosteroid injections are unlikely to provide any meaningful long-term pain relief for patients with sciatica, a review has found.Despite the approach becoming increasingly popular worldwide, the review of 23 “high quality”

randomised trials found it gave only modest, short-term pain relief compared to placebo.

Writing in the Annals of Internal Medicine (online), the authors cautioned against using the injections, especially for acute sciatica.

“The small size of the treatment effect challenges the clinical utility of this procedure,” wrote the authors, who included Professor Chris Maher, director of musculoskeletal research at the George Institute, Sydney.

Patients in the trials ranked their referred leg pain and disability on scales from 0 (no pain or disability) to 100 (worst possible pain or disability).Three months after corticosteroid injections, leg pain was reduced by six points on average and disability by three points.

Beyond 12 months, pain reduction was even smaller and not statistically significant.
“Until the current evidence changes, we would recommend patients with acute sciatica receive a course of conservative care before any invasive approach is considered.”

Injections were given using either a caudal, interlaminar or transforaminal approach, with no clear difference in pain reduction between the three.

The corticosteroids used were either methylprednisolone, prednisone/prednisolone, triamcinolone or betamethasone.

Source: Annals of Internal Medicine website