Epidural steroid shots do little to relieve back pain caused by sciatica and should only be considered as a last resort, according to a new study in the Annals of Internal Medicine.
In a review of nearly two dozen clinical studies involving thousands of patients, Australian researchers found that epidural corticosteroids injections had no long-term effect on sciatica back pain and only a short-term effect on leg pain.
“The available evidence suggests that epidural corticosteroid injections offer only short-term relief of leg pain and disability for patients with sciatica. The small size of the treatment effects, however, raises questions about the clinical utility of this procedure,” wrote lead author Rafael Zambelli Pinto, a PhD student at the University of Sydney.
Epidural steroid shots have been in the news lately because of a deadly outbreak of fungal meningitis caused by a contaminated steroid. The procedure is increasingly being used to treat back pain of all kind, with nearly 9 million spinal injections in 2011.
Sciatica is a relatively common form of low back and leg pain caused by the compression of nerves in the spine. The pain can be severe, especially in cold weather. There may also be numbness and a tingling sensation in the leg.
“Until the current evidence changes we would recommend patients with acute sciatica receive a course of conservative care before any invasive treatment approach is considered,” the researchers said. “For those patients who have persistent and disabling sciatica symptoms, epidural corticosteroids and surgery are the available treatment options, with short-term effects that need to be considered in the shared decision-making process.”
The results and recommendations are similar to those in another study published in April in the Annals of Internal Medicine. Researchers at John Hopkins School of Medicine found that epidural steroid shots worked no better on patients than the anti-inflammatory drug Enbrel or a placebo.