Sciatic nerve pain is a debilitating collection of pain symptoms that arise from an underlying condition. The sciatic nerve is the longest, widest nerve in the body, originating from the lumbar spine and running through the buttocks and down both legs.
Causes of sciatic nerve pain
The most common cause of sciatic nerve pain is herniated or bulging disc, but there are other causes, including:
Many people believe that sciatica is a condition on its own, but it is just the name given to a collection of symptoms that can occur at any place on the sciatic nerve. These symptoms may include:
- Pain in the lower back
- Pain in the hip
- Pain in the thigh or calf
- Burning sensation
- Pins and needles (tingling)
In very rare cases, patients may experience loss of bowel or bladder control. This is a medical emergency that requires immediate attention.
Once the underlying cause for sciatic nerve pain is identified, doctors will work to put together a comprehensive treatment plan that addresses not only pain but also helps to treat the underlying cause. Treatment is offered from least invasive to most, trying to find the least invasive way to resolve the sciatic nerve pain. Somewhere in the middle of this continuum is epidural steroid injections for sciatic nerve pain.
Epidural steroid injections for sciatic nerve pain
Epidural steroid injections are a minimally-invasive treatment often utilized for sciatic nerve pain that has not responded to other treatments. An anesthetic and steroid are injected directly into the epidural space in the spinal column. This placement allows the medicine to treat both sides of the spine. Because the injection is placed in the epidural space (instead of in a specific facet joint, as in facet joint injections), there is more coverage of affected nerves in the spine.
Potential side effects or reactions to these injections may include:
- Sleep disorders
- Hot flashes
- Increased risks of bleeding
- Temporary increases in blood sugar (important to note for diabetic patients)
- Potential temporary increases in pain
- Water retention
The prevalence and severity of side effects seems to depend on the proper skill and placement of the needle as well as the overall health of the patient at the time of the injection. There are health conditions that can complicate this procedure such as hypertension; pre-existing diabetes, cardiovascular issues, or infections; and hypersensitivity to steroids.
Overuse of steroids can also lead to bone loss and weakened connective tissue at the site of injection. While some doctors recommend multiple injections several weeks apart for best relief of pain, others caution against too many injections and prefer to spread treatment out over the course of a year.
Do epidural steroid injections work for sciatic nerve pain?
This is the million dollar question that has become controversial in the past two years. A review of 30 placebo control studies found that epidural steroid injections offered little to no relief for two specific lower back pain conditions: spinal stenosis and radiculopathy. Spinal stenosis is a major cause of sciatic nerve pain.
Those who take issue with the study’s findings believe that the analysis is flawed. Laxmaiah Manchikanti, MD, chairman and CEO of the American Society of Interventional Pain Physicians and the medical director of a pain clinic in Paducah, Kentucky, was lead researcher for several of the studies reviewed by Roger Chou, MD, a professor at Oregon Health & Science University (OHSU) School of Medicine and a staff physician in the Internal Medicine Clinic at OHSU.
Manchikanti pointed out that the review didn’t look at “before and after” results for each individual study, noting:
“Consumers need to understand that the design of their systematic review is flawed and that significant bias exists in the reporting of the results. It is like eating 2 bananas from different countries and saying both are equally sweet, so neither is sweet. They also are looking for the differences in improvement between both groups rather than how a patient has improved from before the treatment to after the treatment.”
Other objections to this review’s findings are that the review did not note the importance of fluoroscopic guidance for needle placement (an important factor) and that all types of pain being treated were lumped together in the same category rather than separating out different types.
On the other hand, the researchers are standing by their analysis. As for patients that showed improvement in the review, Dr. Chou believes that most improvement can be linked to the placebo effect, saying:
“It’s clear that interventions for back pain have a very high placebo effect. We’ve known that for decades and [it’s] been demonstrated over and over again.”
The bottom line
Whether epidural steroid injections work for sciatic nerve pain seems to rely heavily on the type of injection. There are three types of epidural steroid injections – interlaminar, transforaminal, and caudal. Of the three, there is clinical research proving the effectiveness of transforaminal epidural injections. While interlaminar epidural steroid injections are applied in between two vertebrae, transforaminal injections target only one side of the spine above a specific nerve root for more targeted relief.
Other studies point out that both types of injections are equally effective (or ineffective, depending on the study) at relieving radiating back pain similar to sciatic nerve pain.
Because there is so much controversy surrounding epidural steroid injections in general, it is important to have a conversation with your doctor about all options available for sciatic nerve pain. Some patients find great pain relief with this treatment, but others do not. Working closely with a pain management specialist who is familiar with your case and open to looking at treatment in a comprehensive, holistic manner can help you make a better informed choice about whether or not epidural steroid injections for sciatic pain will work for you.
Tell us: Have you tried epidural steroid injections for sciatic nerve pain? What was the result?