Nov 13 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
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.
(Reporting from New York by Andrew Seaman at Reuters Health;
editing by Elaine Lies)