Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Viewpoint
  • Published:

Epidural corticosteroid injections for sciatica: placebo effect, injection effect or anti-inflammatory effect?

Nature Clinical Practice Rheumatology volume 2, pages 518–519 (2006)Cite this article

Sciatica resulting from disk herniation resolves in 70% of patients within 1 month, and in 90% of patients after 1 year, following nonsurgical treatment.1 Although sciatica is usually caused by a mechanical abnormality, pathophysiologic considerations provide a sound rationale for local corticosteroid therapy; several lines of evidence suggest that biochemical factors might contribute to sciatica.2 There is also evidence that such treatment should be initiated in the early stages of disease, in order to prevent persistent nerve-root pain caused by peripheral and central sensitization.3

Epidural corticosteroid injection (ECI) has been part of the nonsurgical treatment of sciatica for nearly half a century, and is widely used in everyday clinical practice. Numerous open-label studies have found that approximately 65% of patients see a benefit. A total of 15 prospective, randomized, controlled studies have been conducted to investigate this effect;4 of these, six studies found that ECI was effective in relieving pain over a period of 7 days to 1 month (no effect was shown beyond one month of treatment). Only one study found that the proportion of patients who returned to work within the first 3 months after treatment was higher in the ECI group than in the control group. None of the results suggested that the injections were associated with a reduced need for surgical treatment. In the remaining nine studies, there were no differences between the ECI group and the control group.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Saal JA and Saal JS (1989) Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy: an outcome study. Spine 14: 431–437

    Article  CAS  Google Scholar 

  2. Goupille P et al. (1998) The role of inflammation in disk herniation-associated radiculopathy. Semin Arthritis Rheum 28: 60–71

    Article  CAS  Google Scholar 

  3. Boulu P and Benoist M (1996) Recent data on the pathophysiology of nerve root compression and pain. Rev Rhum Engl Ed 63: 358–363

    CAS  PubMed  Google Scholar 

  4. Valat JP et al. (2003) Epidural corticosteroid injections for sciatica: a randomised, double blind, controlled clinical trial. Ann Rheum Dis 62: 639–643

    Article  CAS  Google Scholar 

  5. Carette S et al. (1997) Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 336: 1634–1640

    Article  CAS  Google Scholar 

  6. Arden NK et al. (2005) A multicentre randomized controlled trial of episural corticosteroid injections for sciatica: the WEST study. Rheumatology 44: 1399–1406

    Article  CAS  Google Scholar 

  7. Riew KD et al. (2000) The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. J Bone Joint Surg 82-A: 1589–1593

    Article  CAS  Google Scholar 

  8. Karppinen J et al. (2001) Periradicular infiltration for sciatica. A randomized controlled trial. Spine 26: 1059–1067

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Professor of Rheumatology at the Médicine Faculty of François-Rabelais University in Tours, France

    Jean-Pierre Valat

Authors
  1. Jean-Pierre Valat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean-Pierre Valat.

Ethics declarations

Competing interests

The author declares no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Valat, JP. Epidural corticosteroid injections for sciatica: placebo effect, injection effect or anti-inflammatory effect?. Nat Rev Rheumatol 2, 518–519 (2006). https://doi.org/10.1038/ncprheum0286

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncprheum0286

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing