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Brett Sears

Back Pain and Sciatica: Are Steroid Shots the Best Option?

By May 8, 2012

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If you have low back pain and sciatica, you may have tried many different treatments to find relief and to improve your ability to function. Your doctor may prescribe medication, physical therapy, or spinal decompression to attempt to treat your problem.

Epidural steroid injections are another common way to non-surgically treat the low back and leg pain associated with sciatica. The medicine is usually a steroid that is injected in your spine near the inflamed lumbar nerve. This steroid helps to decrease pain and swelling around the nerve root, and thus, offer relief from sciatica.

A study recently published in the Annals of Internal Medicine examined the effect of three different injections in the spine. The researchers randomized 85 patients with lumbar radiculopathy of less than 6 months duration into three groups. One group received injections of steroids, one group received etanercept (an arthritis medication with the trade name Enbrel), and the third group received normal saline injections. All participants received two injections spaced two weeks apart.

The main outcome measure in the study was leg pain one month after the second injection was administered.

The results indicate the there was more improvement in symptoms with the epidural steroids, but the improvement was not statistically significant when compared to etanercept or saline. That's right-your doctor could possibly inject salt water into your back to treat your lumbosacral radiculopathy, and this may help improve your pain level just as effectively as steroids. Of course, your doctor would never do such a thing, but the thought is pretty interesting.

Bottom line: for a specific group of patients, injection of steroids into the spine can help with the pain associated with sciatica. The trick is identifying those people, and identifying those patients who would not benefit from such a procedure.

What does help low back pain and sciatica? Most studies indicate that exercise and education are some the best and safest treatments for lumbosacral radiculopathy. Which exercises are best? A visit to your physical therapist can help find the right exercises for your specific condition.

Comments
August 12, 2012 at 8:13 pm
(1) Angie says:

My doctor is giving me saline injections. Why do you say that a doctor would never do such a thing?

August 13, 2012 at 8:42 am
(2) physicaltherapy says:

Angie,
Saline is just salt water, and there is very little evidence that injecting saline into your back will help sciatica. If your doctor is treating your sciatica with saline injections, perhaps you should ask a few questions to understand why. He or she may have some insight into the use of saline for sciatica.
Thanks for your comment!
~Brett

September 19, 2012 at 4:11 pm
(3) superdrol says:

Hi physicaltherapy.about.com is cool i love to read your content
superdrol cycle

October 30, 2012 at 7:50 am
(4) jon says:

little evidence? you just cited an empirical study that found saline is, statistically speakung, just as effective as epidural to treat pain.

meanwhile, I think it’s pretty interesting. any possible side effects of over injecting and flooding the joints or diluting important things…like blood?

October 31, 2012 at 11:53 am
(5) physicaltherapy says:

Jon,
Great comment! I think the issue here is that many people get better just by being treated, regardless of what is being used to treat. Injecting saline into the spine isn’t done because people cannot explain the mechanism of action of why it works. You do raise an interesting point.
I am unaware of possible side effects of injecting saline into the back. Perhaps a good question for your doctor… Diluting the blood seems like a bit of a stretch, just given the sheer volume of blood in the body compared to the minor volume of medicine (or saline) injected.

Again, thanks for your comment!
~Brett

January 26, 2013 at 7:01 am
(6) Ashley says:

Hello, I just had a mri that proved I have two herniated discs that are pressing on my nerves causing severe pain down my leg. I’m just wondering if you believe that these shots will work or if surgery is really the only possible treatment. I’ve tried chiropractic and exercise but nothing has worked so fat. This pain is getting so bad that I can hardly even stand sometimes.

January 28, 2013 at 9:46 pm
(7) physicaltherapy says:

Ashley,
Thanks for your comment. I recently was discussing this with a friend who is a neurosurgeon. He recently completed a retrospective analysis of his patients who have had injcetions for herniated discs. Essentially, about 66% of the time the shots were effective. So three people must get the shot to help two. Now remember this is coming from the doctor who performed the shots…perhaps a little bias may be at play here.
If you have tried everything conservative and you have positive evidence of HNPs pressing on nerves, a shot may be worth a try before jumping into surgery. The cortisone may help decrease the swelling around the nerves and discs to allow normal pain free movement to occur. Just be sure to have a discussion with your doctor and ask a lot of questions.

Good luck, and thanks for your comment.
Brett

February 8, 2013 at 1:53 pm
(8) pain free says:

Your spine has discs in between each vertebra. When you sleep at night, your discs increase size and become more susceptible to bulging/herniating. Therefore, you must avoid bending improperly for at least one hour after you awake to allow the discs to shrink in size. People frequently bend down to put on their socks and pants when they awake. Instead, bring your feet up to you to complete this task. Otherwise, make sure you bend properly so that you don’t injure your spine during that one hour period.

March 22, 2013 at 11:12 am
(9) Maria says:

I have two herniated discs that are pressing on my nerve roots causing severe sciatic pain. i’d consider ESI, but after i saw a video on how it’s done i freaked out, i would like to know if there is any possibility that i’d be fully anesthetized during the process…Thank You

March 23, 2013 at 2:27 pm
(10) physicaltherapy says:

Maria,
The doctors that I know who perform this procedure do NOT use general anesthesia to perform the injection. You should speak with your doctor about your concerns.

Good luck,
Brett

June 3, 2013 at 4:15 am
(11) Mitchstar says:

Hi just reading some comments and if you have sciatica that is bad then you can definitely handle a small jab in back hardly compares to sciatic pain ha. Had my injection 6 hrs ago hoping that this works . Had stress fracture in L5 disc 5 weeks ago back came right in a week so stress fracture may have already been there previously just aggravated it . Went back to work tentatively at first started developing pain in leg hello sciatica 3 weeks later still there sick of masking with medication so hit doc up for injection and he said give it a try !

June 16, 2013 at 8:00 am
(12) lipidzlady says:

Mechanical Diagnosis and Therapy (aka McKenzie therapy) can be very effective in treating sciatica. Ron Donelson has written several journal articles on it (http://www.ncbi.nlm.nih.gov/pubmed/21292146 is one, from 2011). Of note- some sciatica patients who do no respond to MDT initially DO respond after epidural injection. This was also reported for cervical (neck) radiculopathy in http://www.ncbi.nlm.nih.gov/pubmed/23113937. So, if at first you don’t succeed, try MDT again! One last thought- you can try treating yourself, but I found it essential to have guidance from an MDT-credentialed provider. My heart goes out to your readers. Hope they are pain free soon!

September 19, 2013 at 8:39 am
(13) Curious says:

in papers today that saline solutions will eradicate back pain, you say in your study it was just as good as steroid injections, so why do you say a dr. would never use it? Too cheap – doesnt get his cut from pharmacy company?? If something works, why would you not use it? And as you say it’s saline – salted water, so harmless compared to other things and cheaper?

September 19, 2013 at 11:40 am
(14) Jen says:

So I had back surgery 5 months ago for a herniated L4L5 disk pushing on my sciatica along with a foramenectomy hoping to help with my very irritated sciatic nerve. Only to now know that my “back” feels better but my leg is still killing me. The doctor is now suggesting steroid injections. I just don’t know if this is the correct way to go since it seems many people don’t have long term success. What type of doctor is the best to discuss this issue with a neurologist or an orthopedic?

October 2, 2013 at 8:16 pm
(15) physicaltherapy says:

Jen,
Thanks for your comment. Either doctor is qualified to discuss steroid injections and ongoing leg pain after surgery with you.

Did you try some PT after your surgery? Might I suggest a visit to a McKenzie trained PT. You can find one at http://www.mckenziemdt.org.

Good luck,
Brett

February 9, 2014 at 11:54 pm
(16) Marbie says:

Hi! Dr Brett please help me with a medical question. I am new to the computer so please excuse faults. I am 50 and have had 1 fusion laminectomy , and 2 more lamonectomies followed. I have recently been told I have as many as 5 collapsed disc and I am setting here not understanding really what that means. Due to blood clots and prior surgeries no specialist knows how to help. I have been getting steroid shots off and on and am setting here tonight in extreme pain, my right lower back is swelling and has moved around to my right side, the pain going down my r leg is unbelievable and my inner thigh not outer is very painfull. I see my primary doctor tomorrow and I called her due to these symptoms. My dr will probably give me another steroid shot. I am walking but I here and feel a teribli clicking feeling in my lower right back. I beg of you please help me in some way. I hope you will please shed some light of information. THANK YOU !

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