Epidural steroids offer only short-term relief from sciatica, concludes analysis

The study

Australian reviewers extracted data from 23 randomised placebo-controlled trials that assessed the efficacy of epidural corticosteroid injections in participants with sciatica. Outcome data for leg pain, back pain, and disability were followed up for more than 12 months.

The findings

They showed a modest, significant effect of epidural corticosteroid injections compared with placebo for leg pain and also for disability in the short term, with mean differences of -6.2 and -3.1 compared with placebo. There were no statistically significant benefits seen with epidural corticosteroids in the long-term, compared with placebo.

What does it mean for GPs?

The available evidence suggests that epidural corticosteroid injections offer short-term relief of leg pain and disability for patients with sciatica. However the small benefit seen with treatment raises questions about the clinical benefit of this procedure in the target population.

Expert comment

Dr Louise Warburton, a GP in Staffordshire and president of the Primary Care Rheumatology Society: ‘There is no evidence to suggest that the widespread use of corticosteroid injections will improve the outcomes for sciatica and cannot be endorsed for use within the NHS. However, I am sure that certain patients will respond favourably to an epidural steroid, but more research is required to identify the potential responders.’

Annals of Internal Medicine 2012; 157(12): 865-877