Epidural Treatment for Sciatica

Sciatica pain is potentially severe and comes from a pinched nerve in the lower back. The pain can radiate from the back down into the leg and occasionally even the foot. Epidural steroid injection is a nonsurgical treatment than can reduce inflammation around the pinched nerve. Doctors usually order this treatment when more conservative measures, such as medication and physical therapy, fail. Epidural treatment is widely performed and carries little danger, but some physicians and researchers doubt its effectiveness.

Benefits

• Unlike oral steroid medication, an epidural sends steroids, or cortisone, right to the source of pain. Steroids can effectively decrease inflammation that is causing pain. Sometimes a physician includes a saline solution in the injection. This helps flush out inflammatory chemicals that can worsen sciatica pain. Epidural injection of steroids eliminates the unpleasant side effects that oral steroids can cause.

Procedure

• Epidural injections are usually performed in an outpatient surgery center or a doctor's clinic with the patient lying on his stomach partially sedated. The entire procedure takes less than 30 minutes. Using fluoroscopy, or live X-ray, a doctor puts a needle into the epidural space in the spine and slowly injects a steroid solution. The patient is monitored for about 20 minutes before leaving.

Time Frame

• Sciatica pain relief from an epidural is not permanent, but some patients see a decrease in pain for about three months up to a year. For people experiencing severe acute pain, an epidural can provide enough relief for them to go through rehabilitative physical therapy. The combination of an epidural and physical therapy can sometimes provide pain relief for up to three years. Most patients should have no more than three epidural treatments in one year.

Indications

• There are several conditions that can cause severe sciatica pain, including spinal stenosis, where the spinal canal narrows, and degenerative disc disease, where the spinal disc space puts pressure on nerves. A lumbar disc herniation, where the disc puts pressure on both the spinal cord and nerves, is another cause. Cysts and compression fractures in a vertebra can also cause sciatica pain. Epidural treatments are used for all types of sciatica pain.

Warning

• Patients with infection or bleeding problems should not receive an epidural injection. High-dose aspirin treatment and anti-platelet drugs, such as Plavix, should be discontinued before an epidural procedure. Additionally, patients with diabetes, renal disease and congestive heart failure may be poor candidates for epidural injections.

Theories/Speculation

• Epidural treatment for sciatica pain is somewhat controversial. Although the American Academy of Orthopaedic Surgeons and the National American Spine Society have both approved epidural treatment for sciatica and it is routinely done, some research shows there is often no long-term relief from this treatment. A study from the American Academy of Neurology showed most patients received pain relief for only about six weeks. The American Family Physicians organization says there is limited evidence that epidural treatment is effective. Nevertheless, this continues to be a popular treatment for sciatica pain.