Epidural corticosteroid injections may offer only short-term relief of leg pain and disability for patients with sciatica, suggests a recent review of published studies.
Existing guidelines and systematic review provide inconsistent recommendations for epidural corticosteroid injections for individuals with sciatica. Rafael Zambelli Pinto, MSc, and colleagues pooled data from 25 reports, including 23 trials (Ann Intern Med. 2012;157(12):865-877).
The pooled results showed a significant — although small — effect of epidural corticosteroid injections compared with placebo for leg pain in the short term and for disability in the short term. The long-term pooled effects were found to be smaller and not statistically significant.
Specifically, at short-term follow-up — between two weeks and three months —14 studies involving a total of 1,316 patients showed that the injections offered significant relief from leg pain compared with placebo. Ten of the trials, involving a total of 1,154 participants, revealed a significant effect of injections for reducing disability, and six trials involving a total of 723 patients showed that the injections had no effect on back pain.
One year or longer later, no difference was seen in leg pain, back pain, or disability between the patients given epidural corticosteroid injections and those receiving placebo.
“The small size of the treatment effects…raises questions about the clinical utility of this procedure in the target population,” the researchers wrote.