Sciatica not helped by epidural steroid injections

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Sciatica not helped by epidural steroid injections



November 3, 2005



Janis

Southampton, UK - Epidural corticosteroid injections (ESIs) for

sciatica provide no sustained improvements in pain, function, return

to work, or need for surgery for patients, according to a placebo-

controlled trial reported in the November 2005 issue of Rheumatology

[1].

" ESIs have only a limited role [in managing sciatica] and should

definitely be used less frequently. They may have a role as part of a

multidisciplinary package of care but have almost no role as a single

intervention in these patients, " lead author Dr Nigel K Arden

(University of Southampton, UK) tells rheumawire.

Results generally disappointing



" ESIs have only a limited role [in managing sciatica] and should

definitely be used less frequently. "

This study randomized 228 patients with a clinical diagnosis of

unilateral sciatica lasting one to 18 months to either three lumbar

ESIs of triamcinolone acetonide or three interligamentous injections

of saline. Injections were given at weeks 0, 3, and 6. Change in the

Oswestry low back pain disability questionnaire (ODQ) was the primary

study end point. The researchers reported efficacy data at week 12

for 85 of 120 ESI patients and 76 of 120 placebo patients. They also

reported week-52 efficacy data for 48 of 120 ESI patients and 42 of

120 placebo patients.

These results were generally disappointing. At three weeks after the

first injection, the ESI patients reported a statistically

significant improvement in function (score improved from baseline

10.3 points vs 6.6 for placebo, p=0.017), and more ESI patients

achieved a 75% improvement in the ODQ (12.5% vs 3.7%, p=0.016).

However, ESIs did not significantly improve leg pain as reported by

visual analog scale (VAS). At three weeks, the number needed to treat

(NNT) to achieve a 75% improvement over placebo injection was 11.4.

The improvement seen at week 3 was gone by week 6, and no significant

difference in any outcome measure was observed at any other point out

to week 52. The researchers also observed that multiple ESIs were no

more effective than single injections.

The investigators conclude, " In this study there was no benefit of

ESI in the medium or long term in terms of pain relief, utilization

of further health services (including surgery), or return to work.

Because of the high cost, the use of ESIs in medium- to long-term

patient management strategies can therefore be regarded as an

inefficient use of resources by the health provider. "

" Sciatica often has a prolonged course and causes significant

disability. Management should performed in a multidisciplinary

setting and should not be driven by ESIs, " Arden said.

Arden NK, Price C, Reading I, et al. A multicenter randomized

controlled trial of epidural corticosteroid injections for sciatica:

the WEST study. Rheumatology 2005; 44:1399-1406. 16030082

http://www.jointandbone.org/viewArticle.do?primaryKey=589789