Benefits of epidural for back pain modest

Epidural Steroid Shot May Offer Modest Benefit in Sciatica
Epidural Steroid Shot May Offer Modest Benefit in Sciatica

HealthDay News -- Epidural injections provide only modest, short-term pain relief from lumbrosacral radiculopathy and improvements in functional capacity, whether used with steroids or the anti-inflammatory biologic etanercept (Enbrel), clinical trial results indicate.

After one month, neither therapy significantly reduced leg or low back pain compared with saline injections, Steven P. Cohen, MD, of Johns Hopkins, and colleagues reported in Annals of Internal Medicine. Larger, longer-term studies are needed to confirm a benefit, they wrote.

The researchers compared epidural steriods, etanercept and saline among 84 patients with lumbosacral radiculopathy of less than six months in duration. Pain and function were assessed for patients who were randomly assigned to receive treatment with two epidural injections (total volume of 2 mL), delivered two weeks apart. These consisted of 60 mg of methylprednisolone or 4 mg of etanercept and normal saline.

At one month, scores for leg pain on a 10-point rating scale were similar across groups with mean scores of 2.00 with steroids, 2.39 with etanercept, and 3.59 with saline (P=0.26). Similarly, the proportion of patients who reported improvements in pain after one month did not differ greatly between groups at 80% with steroids and 50% with etanercept or saline (P=0.47).

The researchers also measured functional capacity on the Oswestry Disability Index and found the greatest improvements in the steroid group and the saline control (mean change -20.50 and -12.07), but these findings were not significant. Improvements in the etanercept group were even smaller, with points only falling 2.85 on the same scale, largely because of worsening in sleep and sex life.

Patients in the steroid group had the highest proportion of patients able to reduce their opioid use by one-fifth or stop nonopioid analgesic use completely. They were also able to reduce analgesic use 63% vs. 36% in the etanercept group, but again the findings were not significant (P=0.09).

Overall, 75% of patients treated with steroids experienced leg pain relief of 50% or greater and a positive global perceived effect at one month, versus 42% with etanercept and 50% with saline (P= 0.09).

"Whether higher epidural doses, which have been used successfully in other settings, or a longer-acting TNF [tumor necrosis factor] inhibitor would have additional benefit is uncertain," the researchers wrote.

Study limitations included a lack of generalizability (majority of study participants were military personnel), small group sample sizes, reliance on patient recall to record pain scores at follow-up visits and not performing injections on an "as-needed" basis.

Cohen SP et al. Ann Intern Med. 2012;156:551-559.

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