From the Guidelines
You should not get a steroid injection for sciatica as the first-line treatment, as the evidence suggests that systemic corticosteroids are associated with no clinically significant benefit compared with placebo for acute sciatica or sciatica of unspecified duration 1. Instead, consider conservative treatments like physical therapy, over-the-counter pain medications, and rest for 6-8 weeks before exploring other options. The procedure of injecting corticosteroids into the epidural space around the affected nerve roots aims to reduce inflammation and provide pain relief that can last from a few weeks to several months. However, potential side effects include temporary pain at the injection site, headaches, and rarely, infection or bleeding. It's essential to discuss your complete medical history with your doctor before getting an injection, as steroids may not be appropriate if you have certain conditions like diabetes, infections, or bleeding disorders. Some key points to consider:
- Steroid injections are not recommended as the first-line treatment for sciatica 1.
- Conservative treatments should be tried first, including physical therapy, over-the-counter pain medications, and rest for 6-8 weeks.
- The evidence for the effectiveness of steroid injections for sciatica is limited, and the potential benefits and risks should be carefully weighed before making a decision 1.
- It's crucial to discuss your medical history with your doctor before getting an injection to ensure that steroids are safe for you to use 1.
From the Research
Effectiveness of Steroid Injections for Sciatica
- The use of epidural corticosteroid injections for sciatica has been studied extensively, with evidence suggesting a short-term analgesic effect 2, 3, 4, 5.
- A systematic review and meta-analysis found that epidural corticosteroid injections were effective in reducing short-term leg pain and disability in patients with sciatica, although the effects were small and short-term 3, 5.
- Another study found that epidural steroid injections provided short- and medium-term pain relief for sciatica caused by lumbar disc herniation, but had limited long-term pain-relief effects 4.
Comparison to Placebo
- Studies have compared the efficacy of epidural corticosteroid injections to placebo, with results showing a significant, although small, effect of epidural corticosteroid injections compared to placebo for leg pain and disability in the short term 3, 5.
- A systematic review and meta-analysis found that the overall quality of evidence for the efficacy of epidural corticosteroid injections was moderate, with some studies suggesting a small but significant effect 3, 5.
Safety and Tolerance
- The safety and tolerance of systemic steroids in sciatica have been evaluated, with results suggesting that steroid efficacy is not superior to placebo, but has more side effects 6.
- A study found that the rate of adverse events was higher in the steroid group compared to the placebo group, with a number needed to harm of 20 6.
Clinical Utility
- The small size of the treatment effects of epidural corticosteroid injections raises questions about the clinical utility of this procedure in the target population 5.
- However, some studies suggest that epidural steroid injections may be a viable treatment option for individuals suffering from sciatica, particularly in the short to medium term 4.