Sciatica Relief: Epidural Steroid Injection or Oral Steroids?
Sciatica is a term that describes pain that begins in your lower back and/or hip and runs down the back of one of your thighs and into the leg. Sciatica usually affects one side (eg, left, right leg) of the lower body. It can be caused by a spinal disorder that causes compression (pinching) of the sciatic nerve; the longest and largest nerve in the body.
Sciatica often causes stabbing, burning or tingling sensations, which can last for weeks. Moving around, coughing or sneezing can cause sciatica pain to flare up or increase. You may feel “pins and needles” numbness or weakness down your leg.
Brief Rest, Medication and/or Spinal Injection?
Sciatica usually can be treated without spine surgery. Brief rest (one to two days) and pain relievers such as ibuprofen—a nonsteroidal anti-inflammatory drug (eg, Advil), or acetaminophen (Tylenol) may be recommended. In some cases, the doctor may prescribe medication that relieves nerve pain, such as gabapentin (Neurontin).
While many people with sciatica recover within a few weeks, those who continue to feel pain and sciatic symptoms may undergo an epidural steroid injection. Steroids reduce inflammation and may help ease sciatic pain. During an epidural steroid injection, the medicine is injected near spinal nerve roots that are compressed.
Some patients experience relief from sciatica after one epidural steroid injection, which may last for weeks, months or longer. Unfortunately, a spinal injection doesn’t always improve sciatica. Similar to other medical procedures, an epidural steroid injection has risks, and may not be appropriate for every patient. Furthermore, in April 2014, the U.S. Food and Drug Administration warned that epidural steroid injections could result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death.1
Are Oral Steroids a Treatment Option?
The researchers decided to study the effectiveness of oral steroids because they may provide similar anti-inflammatory effects (eg, reduce inflammation), but aren’t invasive, don’t require an MRI or radiation exposure, and may be of less risk to certain patients. While many doctors prescribe oral steroids for sciatica, until now, there has not been much research into the treatment’s effectiveness.
About the Oral Steroid Study
Researchers from Kaiser Permanente San Jose Medical Center in California studied 269 people with severe leg pain for up to three months. Each study participant had a herniated disc, which triggered leg pain. A herniated disc occurs when the gel-like center of a disc that cushions the bones of your lower spine protrudes into or through the disc’s outer lining.
Participants were randomly assigned to take the oral steroid (prednisone) or a placebo (a pill with no benefit) for 15 days. The prednisone group received 20 milligrams 3 times a day for 5 days; then twice a day for 5 days; then once daily for 5 days—for a total of 600 milligrams. Placebo group participants followed the same dosing schedule. All the patients were followed for up to one year.
Oral Steroid Study Results
Patients who took prednisone reported a modest improvement in ability to function (defined as 50 percent better) at 3 weeks, and one year after they stopped taking the steroid. Pain was similar for both groups.
At 3 weeks, the prednisone group reported side effects, including insomnia, increased appetite and nervousness, at twice the rate as patients in the placebo group. Almost half of the prednisone group reported at least one side effect at 3 weeks. After one year, both groups reported a similar number of side effects.2
Lead researcher Dr. Harley Goldberg, Director of Spine Care Services at Kaiser Permanente San Jose Medical Center, said the study "doesn't slam the door" on steroids as a treatment. The findings provide information for patients and their doctors to consider as they decide on the best treatment option. "Some people could still choose to use it," he said.3
In summary, these conservative treatments will help to make the patient more comfortable while this process takes its natural course. Approximately 80% of patients will recover in 8-12 weeks without surgery.
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