Spinal steroids may have little impact on one type of back pain

Mon Nov 12, 2012 7:34pm EST

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Nov 13 (Reuters) - Steroid shots to treat various kinds of back pain, popular in recent years, do little to alleviate the common condition called sciatica, which causes leg and back pain, according to an Australian study.

In the United States, the use of steroid injections into the spine to treat back pain has surged over the last few years, and a tainted supply of one of the steroids included in the study - methylprednisolone - recently caused a nationwide outbreak of fungal meningitis that infected 400 people and led to 31 deaths.

In the study, which analyzed results from nearly two dozen clinical trials on thousands of patients, Australian researchers found that epidural injections - into the spine - of corticosteroids had no long- or short-term effect on sciatica back pain, and such a short-term impact on leg pain that it would make no difference to the patient.

"I think it's pretty clear that this treatment is not good to do," said Chris Maher, at The George Institute for Global Health in Sydney, Australia, who worked on the study.

For sciatica, which is thought to be caused by nerve damage, past studies have already questioned the effectiveness of spinal steroid shots. A small study earlier this year found that patients who received steroid shots for sciatica had about the same improvement rate as those who received placebos.

Maher and his colleagues analyzed 23 clinical trials, representing about 2,300 patients, whose pain was ranked on a scale of zero to 100, with higher numbers for more pain.

For the back pain part of sciatica, the researchers found that the injections didn't seem to make a difference over short or long periods of time, according to the study published in the Annals of Internal Medicine.

For the leg pain, there was no difference a year or so after the injection, but there was a statistically significant six-point drop in pain scores over the short-term, about two weeks to three months - not enough, Maher said, to mean anything to a doctor or patient.

"You can appreciate that six points on a hundred-point scale is a tiny difference, and in our view that is probably not clinically important," he said.

"We really think the question is closed. So in terms of our research agenda, we're moving on to other treatments for sciatica."

Among those other options are simple pain relievers, such as acetaminophen, drugs that treat pain by working throughout a person's nervous system, and, as a last resort, surgery.

Not everyone agrees that steroid injections should be excluded from the hierarchy of treatments for sciatica. Patients with sciatica from a relatively recent herniated disk who time and medicine have not helped may gain relief, some doctors said.

"In general, I think we've learned over the years that the epidural injections are turning out to be less and less successful... but there are times when they should be considered," said Kirkham Wood, chief of the orthopedic spine service at Boston's Massachusetts General Hospital.

He does believe, though, that the injections - once standard treatment - are overused.

"I think the pendulum is certainly swinging away from their use," he added. SOURCE: bit.ly/SQRXAa (Reporting from New York by Andrew Seaman at Reuters Health; editing by Elaine Lies)

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