Steroid injections DON'T work for back and leg pain

  • Steroid injections had no long-term effect on sciatica pain, according to a review of clinical trials
  • Researchers say conventional painkillers should be used instead and surgery as a last resort

By Daily Mail Reporter


Sciatica causes shooting pains in the lower back or more commonly down one leg

Sciatica causes shooting pains in the lower back or more commonly down one leg

Having steroid injections to ease back pain could be a waste of time, after researchers found they do little to alleviate sciatica.

The condition, which is a common form of leg and back pain, is caused when the sciatic nerve becomes compressed. This is most usually caused by a slipped disc.

Steroid injections are one of the treatment options on offer in the UK and U.S if painkillers and exercise fail to work.

Now Australian researchers have found that corticosteroid injections into the spine had no long or short-term effect on sciatica back pain.

They also had such a small short-term effect on leg pain that it made little difference to the patient.

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

Yet the use of epidural steroid injections to treat back pain of all sorts among Medicare patients nearly doubled from 741,000 in 2000 to about 1,438,000 in 2004, according to the researchers.

In the U.S., the cost of one shot can be several hundred dollars. It is also an option on the NHS in the UK.

For sciatica, which is thought to be caused by nerve damage, past studies have already questioned the effectiveness of spinal steroid shots.

Dr Maher and his colleagues set out to see whether past studies supported the use of epidural corticosteroid injections to help manage sciatica.

The team analysed the results from 23 clinical trials on thousands of patients. Each patient's pain was ranked on a scale from zero to 100 - with higher scores representing worse pain.

For the back pain component of sciatica, the researchers found that the injections didn't seem to make a difference over short or long periods of time.


When it came to 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 - up to three months afterwards.

But that, according to Maher, is not enough 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,' he added.

'So in terms of our research agenda, we're moving on to other treatments for sciatica.'

However, not everyone agrees that steroid injections should be excluded from the hierarchy of treatments for sciatica.

'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 Dr Kirkham B. Wood, from Boston's Massachusetts General Hospital.

He believes an injection should be considered, for example, in someone with sciatica resulting from a relatively recent herniated disc, 'who time and medication has not helped.'

Wood does believe, however, that the injections are overused, and said there was a time when the injections were the go-to treatment for simple back pain.

'I think the pendulum is certainly swinging away from their broad use,' he said.

The fungal meningitis outbreak in the U.S., caused by a tainted supply of the steroid methylprednisolone will also likely dampen enthusiasm for the jabs, researchers acknowledged.

'If this was a treatment that worked, then you'd have to weigh the benefits and the harm,' Maher said.

Maher and his team, who published their results in the Annals of Internal Medicine on Monday, hope doctors will pick up on their findings but said it could take a while.


The comments below have not been moderated.

Like others here I've had sciatica on and off for 18 years and have never been offered an injection.

Click to rate     Rating   1

Poor patient selection is the problem, particularly within the studies. It is very difficult to recruit 'appropriate' patients for a study, and this introduces huge amounts of bias. The person performing the injection has to be technically excellent. Epidurals are inappropriate for most, as the injection goes everywhere except where there is compression. Selective nerve root injections are much better. Most 'meta-analyses' in the medical literature are done for career enhancement purposes.

Click to rate     Rating   3

I had very bad sciatica about ten years ago and up to three years ago.However owing to deliberately walking more its gone apart from a short period some times when waking up.I think muscle tone is the answer,not drugs!

Click to rate     Rating   4

I became paralysed for 2 years after a steroid epidural for spinal arthritis went badly wrong . Was never told of this side effect beforehand :-(

Click to rate     Rating   6

Can you see where this is going? Expensive injections = 0 profit. Cheap painkillers sold to the NHS for huge mark ups = Happy Shareholders

Click to rate     Rating   11

I've had over twenty of these injections over the past ten years (private then NHS). There are other treatments out their, but they are too expensive: I live in the 'wrong' postcode and therefore I am denied these costly treatments. I am moving out of Kent and moving to Scotland next year. Maybe then, I'll get the treatment for my spinal injuries, which I've had for the past 25 years.

Click to rate     Rating   9

I have lumbar scoliosis due to an old burst vertebral fracture. No sciatica and no trapped nerves but the back muscles are stressed and inflamed and sometimes spasm - the facet injections help tremendously and last a couple of years so maybe it depends on why you are in pain.

Click to rate     Rating   12

I had my injections done again monday. Yes, sometimes they don't work, but when they do it makes a tremendous difference to the quality of my life. Thank you Dr. Gilkes at the Homerton Hospital.

Click to rate     Rating   15

Certainly worked for me. I've had two frozen shoulders, one in each arm and cotizone injections cleared them in minutes.

Click to rate     Rating   15

The shots are the only thing that work for me. You can ice and take pain pills for weeks then get one shot and relief in two days. Lasts almost a year. Doesn't help everyone but one shot a year keeps me going.

Click to rate     Rating   15

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