นักวิจัยชาวออสเตรเลียพบว่าการฉีดสเตียรอยด์ corticosteroid injections เข้ากระดูกสันหลังไม่มีผลระยะสั้นและระยะยาวเลยกับการรักษาอาการปวดหลังปวดตะโพก และให้ความแตกต่างเล็กน้อยในผู้ป่วยที่มีอาการปวดขา
Steroid injections DON’T work for back and leg pain
- Steroid injections had no long-term effect on sciatica pain, according to a review of clinical trials
- Researchers say conventional painkillers should be used instead and surgery as a last resort
By DAILY MAIL REPORTER
PUBLISHED: 13:49 GMT, 13 November 2012
Having steroid injections to ease back pain could be a waste of time, after researchers found they do little to alleviate sciatica.
The condition, which is a common form of leg and back pain, is caused when the sciatic nerve becomes compressed. This is most usually caused by a slipped disc.
Steroid injections are one of the treatment options on offer in the UK and U.S if painkillers and exercise fail to work.
Now Australian researchers have found that corticosteroid injections into the spine had no long or short-term effect on sciatica back pain.
They also had such a small short-term effect on leg pain that it made little difference to the patient.
‘I think it’s pretty clear that this treatment is not good to do,’ said Chris Maher, of The George Institute for Global Health in Sydney, Australia, who worked on the study.
Yet the use of epidural steroid injections to treat back pain of all sorts among Medicare patients nearly doubled from 741,000 in 2000 to about 1,438,000 in 2004, according to the researchers.
In the U.S., the cost of one shot can be several hundred dollars. It is also an option on the NHS in the UK.
For sciatica, which is thought to be caused by nerve damage, past studies have already questioned the effectiveness of spinal steroid shots.
Dr Maher and his colleagues set out to see whether past studies supported the use of epidural corticosteroid injections to help manage sciatica.
The team analysed the results from 23 clinical trials on thousands of patients. Each patient’s pain was ranked on a scale from zero to 100 – with higher scores representing worse pain.
For the back pain component of sciatica, the researchers found that the injections didn’t seem to make a difference over short or long periods of time.
When it came to leg pain, there was no difference a year or so after the injection, but there was a statistically significant six-point drop in pain scores over the short term – up to three months afterwards.
But that, according to Maher, is not enough to mean anything to a doctor or patient.
‘You can appreciate that six points on a hundred-point scale is a tiny difference, and in our view that is probably not clinically important,’ he said.
‘We really think the question is closed,’ he added.
‘So in terms of our research agenda, we’re moving on to other treatments for sciatica.’
However, not everyone agrees that steroid injections should be excluded from the hierarchy of treatments for sciatica.
‘In general, I think we’ve learned over the years that the epidural injections are turning out to be less and less successful… but there are times when they should be considered,’ said Dr Kirkham B. Wood, from Boston’s Massachusetts General Hospital.
He believes an injection should be considered, for example, in someone with sciatica resulting from a relatively recent herniated disc, ‘who time and medication has not helped.’
Wood does believe, however, that the injections are overused, and said there was a time when the injections were the go-to treatment for simple back pain.
‘I think the pendulum is certainly swinging away from their broad use,’ he said.
The fungal meningitis outbreak in the U.S., caused by a tainted supply of the steroid methylprednisolone will also likely dampen enthusiasm for the jabs, researchers acknowledged.
‘If this was a treatment that worked, then you’d have to weigh the benefits and the harm,’ Maher said.
Maher and his team, who published their results in the Annals of Internal Medicine on Monday, hope doctors will pick up on their findings but said it could take a while.
SOURCE : dailymail.co.uk