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In patients with acute sciatica (less than 8 weeks), the use of transforaminal epidural corticosteroid injections is associated with a reduction in leg pain and opioid use.
In a recent randomized controlled trial conducted in two Dutch hospitals, transforaminal epidural corticosteroid injections (containing Methylprednisolone and Levobupivacaine) effectively mitigated leg pain in sciatica-affected patients. Researchers explored the effectiveness of steroid injections in patients suffering from acute sciatica lasting less than 8 weeks.
The study involved 141 subjects who were randomly assigned to three groups:
(a) Intervention 1: Received usual care along with transforaminal epidural steroid injections containing 1 ml of 40 mg/ml Methylprednisolone and 1 ml of 0.5% Levobupivacaine
(b) Intervention 2: Received usual care along with transforaminal epidural injection consisting of 1 ml of 0.5% Levobupivacaine and 1 ml NaCl 0.9%
(c) Control group: Received usual care, including oral pain relievers without or with physiotherapy.
The co-primary outcomes, including back pain and leg pain intensity, physical functioning, and recovery, were estimated over a six-month follow-up period. The results indicated no profound differences in co-primary outcomes between groups, except for leg pain, which showed a vital drop in the intervention 1 group when compared to the control group. While secondary outcomes revealed some fundamental differences in surgery and treatment satisfaction, these were witnessed only when comparing the intervention 2 group with the control group.
Post hoc analyses revealed a profound improvement in leg pain (50% reduction) for the intervention 1 group compared to the control group at 3 months. Additionally, both intervention groups reported reduced opioid usage. The researchers concluded that transforaminal epidural steroid injections had a statistically significant effect on leg pain for those dealing with acute sciatica as opposed to usual care. However, no differences were noted in co-primary outcomes. Despite this, transforaminal epidural injections appeared to be linked with reduced opioid usage, prompting the need for further exploration into their potential benefits.
The Clinical Journal of Pain
Effect of Transforaminal Epidural Corticosteroid Injections in Acute Sciatica: A Randomized Controlled Trial
Bastiaan C Ter Meulen et al.
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