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Issue 37 Synovium (Autumn 2012)
Chronic sciatic pain is a thoroughly miserable experience that is often refractory to simple physical treatments. Epidural steroid injections have been popular for many years with pain specialists for treatment of chronic sciatic pain, despite the evidence for efficacy remaining unclear. In a multicentre, blinded, randomised controlled trial of steroid versus saline epidural injection versus sham subcutaneous injection in 116 patients with chronic (>12 weeks) radiculopathy,1 no difference was found between the 3 groups on any outcome measures at 6, 12 and 52 weeks post injection. Disappointing but perhaps not unexpected in patients with chronic pain and suggests that doctors should be discussing other, more evidence-based, chronic pain management strategies with their patients. We might also hope for more effective management strategies for acute radicular pain so that chronicity does not develop.
1. Iversen T, Solberg TK, Romner B et al. Effect of caudal epidural steroid or saline injection in chronic lumbar radiculopathy: multicentre, blinded, randomised controlled trial. BMJ 2011 Sep;343:d5278.