In a recent meta-analysis of 23 randomized trials involving more than 2,000 patients in which epidural steroid injections were compared with placebo for sciatica, epidural steroid injections produced small, statistically insignificant short-term improvements in leg pain and disability (but not less back pain) compared to placebo. This improvement also was only over a short period of time – two weeks to three months. Beyond 12 months, there was no significant difference between groups.1 Patients who have true chemical irritation of a nerve respond well to epidural steroid injections. Remember to classify these patients as so:
- Constant pain
- Recent onset (traumatic or possibly insidious)
- Cardinal signs may be present – swelling, redness, heat, tenderness
- Lasting aggravation of pain by all movements
- No movement found which abolishes pain
- More commonly intermittent, but may be constant
- Certain repeated movements cause a lasting reduction or abolition of pain
- Movements in one direction may worsen symptoms, whereas movements in the other direction will improve them
Make sure you are addressing all the sources of pain and/or compression to the nerve. These are not mutually exclusive groups. Often patients have a mixed presentation.
- Pinto RZ, et al. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med, 2012 Nov 13; [e-pub ahead of print].