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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.Patients who have true chemical irritation of a nerve respond well to epidural steroid injections. Remember to classify these patients as so:

Chemical Pain:

  • 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

Mechanical 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.   

  1. 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].

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