Navigation Links
Steroid Shots for Sciatica: Benefits Only Brief, Analysis Finds
Date:11/13/2012

By Kathleen Doheny
HealthDay Reporter

MONDAY, Nov. 12 (HealthDay News) -- Spinal steroid injections -- the type involved in the current fungal meningitis outbreak in the United States -- provide only short-term relief for sciatica-related leg and back pain, according to a new analysis.

Sciatica, a common type of low back pain, is characterized by intense pain shooting down one leg, along with tingling and numbness, as a result of injury or pressure on the sciatic nerve.

Epidural steroid treatments -- injections into the joint spaces of the spine -- have been used to treat back pain for a half-century, but consistent guidelines for their use are nonexistent, according to the new study, which was published Nov. 13 in the journal Annals of Internal Medicine.

In the new analysis, researchers analyzed 23 clinical trials involving more than 3,100 patients; the trials compared steroid injections to other treatments. Researchers had followed patients for a year or longer, gauging pain relief at various points.

"The review showed that [epidural injections] offered only small, short-term improvement in pain and disability for people with sciatica and had no long-term effect," said study co-author Dr. Chris Maher, professor of physiotherapy at the School of Public Health at the University of Sydney in Australia.

At two weeks and three months after treatment, 10 trials showed leg-pain relief and 14 reported improvements in disability. But after a year or more, no differences were found in leg pain, back pain or disability for those given injections compared to those given a placebo.

"Given that the treatment effect is likely to be small and short term, patients with sciatica should discuss the potential risks involved in [steroid injections] with their doctor before agreeing to the procedure," said Maher, who also is director of the George Institute for Global Health, in Sydney.

The results echo some of the findings of another study, published earlier this year, that concluded that after six months, epidural steroid injections were no better than the anti-inflammatory drug Enbrel (etanercept) or an injection of anesthetic and saline.

Dr. Steven Cohen, professor of anesthesiology and critical care medicine at Johns Hopkins School of Medicine in Baltimore and director of pain research at Walter Reed National Military Medical Center, said the findings shouldn't rule out use of epidural steroid treatment.

"It is likely that, at least in some people, epidurals may decrease the likelihood that they will need surgery -- not because they last so long, but because they decrease pain enough for your body to heal itself and/or prevent those deleterious changes from occurring in the nervous system," Cohen said.

Cohen was a researcher on the study comparing the injections with Enbrel, which was published in April in the Annals of Internal Medicine.

Many factors play into the injections' effectiveness, he said. One is the duration of pain. The longer a patient has had the pain, the less responsive treatment tends to be, not only to injections but also to other therapies.

Risks to patients were not examined, Maher said. These remain a concern, especially since tainted steroid injections have killed 32 people and sickened 438 to date since the fungal meningitis outbreak came to light in September. The contaminated drugs were traced to a compounding pharmacy -- now shut down -- that produced drugs to meet the needs of specific patients. Such specialty pharmacies are regulated by state boards, not the U.S. Food and Drug Administration.

Despite that outbreak, epidural injections for back pain are extremely safe, Cohen said, and ''certainly safer than commonly used alternatives such as surgery or narcotics."

"When you examine alternatives for sciatica, no treatment is very reliable or effective," he said, adding that doctors should be more selective in choosing which patients could benefit from the injections.

Dr. Roger Chou, associate professor of internal medicine at Oregon Health & Science University, in Portland, agreed.

"[This new review] underscores the importance of performing epidural steroid injections judiciously, in patients who have clear indications for it, especially in light of the fungal meningitis outbreak," Chou said. There is no evidence that the injections work, for instance, in those with low back pain without sciatica.

More information

To learn more about sciatica, visit the U.S. National Institutes of Health.

SOURCES: Roger Chou, M.D., associate professor, general internal medicine, Oregon Health & Science University, Portland; Steven Cohen, M.D., professor of anesthesiology and critical care medicine, Johns Hopkins University School of Medicine, and director, pain research, Walter Reed National Military Medical Center, Bethesda, Md.; Dr. Chris Maher, director, George Institute for Global Health, and professor, physiotherapy, School of Public Health, University of Sydney, Australia; Nov. 13, 2012, Annals of Internal Medicine


'/>"/>
Copyright©2012 ScoutNews,LLC.
All rights reserved

Related medicine news :

1. Gatekeeper of brain steroid signals boosts emotional resilience to stress
2. Inhaled Steroids Lead to Big Drop in Asthma Deaths at Texas Hospital: Study
3. Steroid Nasal Sprays Show Small Benefit for Sinusitis: Study
4. Identifying asthma patients who tolerate lower doses of steroids remains problematic
5. Trivedi Beef, LLC Announces Breakthrough Beef Industry Data without the use of Antibiotic Drugs, Hormones or Steroids
6. Low steroid levels linked to increased risk of cardiovascular disease
7. Vitamin D deficiency and poorer lung function in asthmatic children treated with steroids
8. The scientific side of steroid use and abuse
9. Steroids Wont Ease Most Sinusitis Attacks, Study Finds
10. Children taking steroids for asthma are slightly shorter than peers
11. For Mild Asthma, Daily Steroids May Not Be Needed, Study Says
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:3/24/2017)... ... March 24, 2017 , ... The iaedp Foundation, the premier provider ... caring for those suffering from the full spectrum of disordered eating, announced today that ... professionals from nearly all 50 states and several countries converged on the Green Valley ...
(Date:3/24/2017)... ... 2017 , ... Northridge dentists, Dr. Michel Elyson ... apnea and TMJ at their office. TMJ, or temporomandibular joint disorder, has long ... is increasingly being treated at dental offices with newly developed procedures and appliances. ...
(Date:3/24/2017)... ... March 24, 2017 , ... ... of enhancements, upgrading their training and leads programs. , In February, 2017, Empower ... elite sales agents, Performance Partners is designed to teach how to maximize their ...
(Date:3/24/2017)... ... March 24, 2017 , ... “The ... about real people of God in congregations across the United States. “The ... minister ordained in 1964 who has served congregations in seven states throughout his ...
(Date:3/23/2017)... ... March 23, 2017 , ... ... their communities, 16 more public health departments have been awarded national accreditation through ... 4.5 million people into the expanding network of communities across the nation whose ...
Breaking Medicine News(10 mins):
(Date:3/23/2017)... -- Research and Markets has announced the addition of ... to 2025" report to their offering. ... The Global Cryostat Market is poised ... decade to reach approximately $3.5 billion by 2025. This ... given segments on global as well as regional levels presented in ...
(Date:3/23/2017)... 23, 2017 Executive ... through extensive primary research (inputs from industry experts, ... to present the analysis of global heart valve ... and Repair); Replacement Procedure By Technique (Mechanical, Bioprosthetic, ... (Surgical Devices, Balloon Valvuloplasty, Transcatheter Mitral Valve Repair ...
(Date:3/23/2017)... 23, 2017   BioSpace , the leading biotechnology ... with Indiana Biosciences Research Institute and over ... educational institutions to bring the state,s life sciences industry ... map, an artistic representation of the region,s booming biotechnology ... Vice President Mike Pence , a long-time advocate ...
Breaking Medicine Technology: