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Intravenous Steroids of Little Help in Acute Sciatica

PHILADELPHIA, PA -- February 15, 2006 -- Although intravenous (IV) steroid injection reduces pain in patients with severe acute sciatica caused by a herniated spinal disk, the improvement is small and lasts only a few days, according to a study in the Feb. 15 issue of the journal Spine.

Led by Dr. Axel Finckh of Brigham and Women's Hospital, Boston, the researchers studied the benefits of IV "pulse" steroid therapy in 65 patients hospitalized for sciatica related to a herniated intravertebral disk. In this condition, a bulging disk in the spinal column places pressure on a spinal nerve root. The result is pain, weakness, and numbness anywhere along the course of the sciatic nerve, which runs down the back of the leg.

One group of patients received a single IV dose of the steroid methylprednisolone. Patients in the other group were injected with an inactive placebo. Pain and other outcomes were compared between groups.

Leg pain decreased significantly for patients receiving the IV steroid injection. However, the total reduction in pain was small -- on a 100-point scale, only about 6 points better than in the placebo group.

In addition, the improvement lasted only a couple of days. By the third day after treatment, pain scores showed little or no difference between groups. In both groups, pain scores decreased gradually in the 10 days after treatment.

None of the other outcomes studied were significantly different between groups, including disability or signs of nerve root irritation.

Sciatica is a common problem, affecting 40 percent of adults sometime during their lives. Steroids are sometimes used in an attempt to reduce inflammation and pain in patients with sciatica. However, studies of various types of steroid administration -- including injection into the space around the spine (epidural) -- have given mixed results. By providing a high dose of steroid in a short time, IV steroid injection could potentially be more effective.

The new results suggest that IV steroid injection can reduce pain in patients with severe acute sciatica. However, the reduction in pain is small and short-lasting, while the final results are no different than with inactive placebo injection. Although some patients may respond better than others, the researchers conclude that IV steroid injections should probably not be widely used for sciatica.


SOURCE: Lippincott Williams & Wilkins

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