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Corticosteroid use may be unnecessary in treatment for lumbar radicular pain

British researchers found ODI and VAS scores similar at 1 year, regardless of whether patients received a corticosteroid injection.

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MANCHESTER, England — Investigators reported that corticosteroids did not provide additional benefits when used in peri-radicular infiltration for radicular pain.

Researchers at the University Hospitals of Leicester, England, recruited 150 patients in a randomized, double-blind controlled trial. Seventy-six patients received bupivacaine while 74 patients received a combination of bupivacaine and methylprednisolone.

"Corticosteroids have been contraindicated in cases of head injury and ... tuberculosis, so we wanted to see why they would be used in cases of sciatica," said S. Tafazal, FRCS, of Leicester, England. He presented the subgroup analysis findings at the British Orthopaedic Association Annual Congress 2007, here.

The average patient age was 62 years, and 84 patients (56%) were men. More patients were diagnosed with having a disc prolapse than a stenosis.

All patients consented to the randomized tests, and a single surgeon performed all of the injections. The mean follow-up: 20 months.

Tafazal said there was no statistically significant difference in the outcome measures between the groups at 3 months, including changes in Oswestry Disability Index (ODI) (P=.2) or on the Visual Analog Scale (VAS) in terms of back pain (P=.28) or leg pain (P=.67).

At 1-year follow-up, "There was no statistically significant difference in the rate of further interventions in either group. Clinical improvement occurred in both groups of patients," he said, "but there was no significant difference in ODI or VAS between the groups."

Tafazal added: "In the end, corticosteroids did not provide an additional benefit, and there is no difference in the need for further nerve root blocks [in either patient group]," he said.

For more information:

• Tafazal S, Ng L, Chaudhary N, Sell P. The efficacy of corticosteroids in peri-radicular infiltration for radicular pain: a randomized double-blind controlled trial. Presented at the British Orthopaedic Association Annual Congress 2007. Sept. 25-28, 2007. Manchester, England.