Epidural corticosteroid injections for sciatica: placebo effect, injection effect or anti-inflammatory effect?

Access through your institution Buy or subscribe Sciatica resulting from disk herniation resolves in 70% of patients within 1 month, and in 90% of patients after 1 year, following

nonsurgical treatment.1 Although sciatica is usually caused by a mechanical abnormality, pathophysiologic considerations provide a sound rationale for local corticosteroid therapy; several

lines of evidence suggest that biochemical factors might contribute to sciatica.2 There is also evidence that such treatment should be initiated in the early stages of disease, in order to

prevent persistent nerve-root pain caused by peripheral and central sensitization.3 Epidural corticosteroid injection (ECI) has been part of the nonsurgical treatment of sciatica for nearly

half a century, and is widely used in everyday clinical practice. Numerous open-label studies have found that approximately 65% of patients see a benefit. A total of 15 prospective,

randomized, controlled studies have been conducted to investigate this effect;4 of these, six studies found that ECI was effective in relieving pain over a period of 7 days to 1 month (no

effect was shown beyond one month of treatment). Only one study found that the proportion of patients who returned to work within the first 3 months after treatment was higher in the ECI

group than in the control group. None of the results suggested that the injections were associated with a reduced need for surgical treatment. In the remaining nine studies, there were no

differences between the ECI group and the control group. This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your institution Subscribe to

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support REFERENCES * Saal JA and Saal JS (1989) Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy: an outcome study. _Spine_ 14: 431–437 Article  CAS  Google

Scholar  * Goupille P _ et al_. (1998) The role of inflammation in disk herniation-associated radiculopathy. _Semin Arthritis Rheum_ 28: 60–71 Article  CAS  Google Scholar  * Boulu P and

Benoist M (1996) Recent data on the pathophysiology of nerve root compression and pain. _Rev Rhum Engl Ed_ 63: 358–363 CAS  PubMed  Google Scholar  * Valat JP _ et al_. (2003) Epidural

corticosteroid injections for sciatica: a randomised, double blind, controlled clinical trial. _Ann Rheum Dis_ 62: 639–643 Article  CAS  Google Scholar  * Carette S _ et al_. (1997) Epidural

corticosteroid injections for sciatica due to herniated nucleus pulposus. _N Engl J Med_ 336: 1634–1640 Article  CAS  Google Scholar  * Arden NK _ et al_. (2005) A multicentre randomized

controlled trial of episural corticosteroid injections for sciatica: the WEST study. _Rheumatology_ 44: 1399–1406 Article  CAS  Google Scholar  * Riew KD _ et al_. (2000) The effect of

nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. _J Bone Joint Surg_ 82-A: 1589–1593 Article 

CAS  Google Scholar  * Karppinen J _ et al_. (2001) Periradicular infiltration for sciatica. A randomized controlled trial. _Spine_ 26: 1059–1067 Article  CAS  Google Scholar  Download

references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Professor of Rheumatology at the Médicine Faculty of François-Rabelais University in Tours, France Jean-Pierre Valat Authors *

Jean-Pierre Valat View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to Jean-Pierre Valat. ETHICS DECLARATIONS COMPETING

INTERESTS The author declares no competing financial interests. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Valat, JP. Epidural corticosteroid

injections for sciatica: placebo effect, injection effect or anti-inflammatory effect?. _Nat Rev Rheumatol_ 2, 518–519 (2006). https://doi.org/10.1038/ncprheum0286 Download citation *

Received: 20 June 2005 * Accepted: 05 July 2006 * Issue Date: 01 October 2006 * DOI: https://doi.org/10.1038/ncprheum0286 SHARE THIS ARTICLE Anyone you share the following link with will be

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