Steroid Injections for Sciatica from Disc ProtrusionDisc protrusion in the lumbar spine can cause low back pain (LBP) that goes down the leg. The leg pain is often referred to as sciatica. Epidural steroid injection (ESI) is one treatment option for sciatica. The steroid along with a numbing agent is injected into the space around the spinal nerve. The goal is to reduce inflammation and swelling. The result is pain relief.
But does it really work? How long does the effect last? Many doctors debate the use of ESI for sciatica. Many studies have been done but most are not quality studies. Some studies with a good design have too few patients to be considered valid. Other studies with large numbers of patients have a poor design or the researchers turned the data around to prove their point of view.
A review of many studies show agreement on one thing. ESI give patients short-term pain relief from sciatica caused by disc problems. The pain goes away faster. Patients report reduced pain in days with the injection instead of weeks without the ESI. With or without the injection, there isn't much difference in function. It's just a matter of comfort. And the injection doesn't keep patients from having surgery.
Doctors who use ESI should just be aware that it has the benefit of quick pain relief but there are still possible side effects. There is the risk of infection and abscess. There is concern about osteoporosis and bone fractures with repeated injections. This is especially true for older adults who are already taking steroids for other health problems.
One study showed that patients with disc protrusion do better with ESI than patients with disc extrusion. In protrusion, the disc bulges but stays inside its own protective covering. With extrusion, the disc material breaks through the outer layer.
All in all, the experts say that the best solution would be a drug that could give similar pain relief without an injection. The effect should last up to three months in order to compare to ESI.
Linda Pembrook. Are Epidural Steroids Effective for Pain? In Pain Medicine News. March/April 2007. Vol. 5. No. 2. Pp. 1, 24.
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