Steroids May Help Some With Sciatica

April 17th, 2012

FAKE NEWS for the Zionist agenda

MONDAY, April 16 (HealthDay News) — New research suggests that
epidural steroids provided better relief for some patients with sciatica,
a searing pain that shoots from the lower back straight down the leg, than
Enbrel, a newer type of anti-inflammatory drug.

Yet the differences were “modest” and did not reach statistical
significance. And while more patients reported pain relief one month after
receiving epidural steroids, the relief didn’t necessarily last. At six
months, steroids weren’t any better than Enbrel (etanercept) or a third
treatment tested, injections containing saline and a local anesthetic.

“We found a pretty strong suggestion that steroids were better than
both of the other treatments, and the etanercept wasn’t better than
saline, in the short-term,” said study author Dr. Steven Cohen, a
professor of anesthesia at Uniformed Services University of the Health
Sciences and director of pain research at Walter Reed Army Medical Center,
in Bethesda, Md.

The study is published in the April 17 issue of the Annals of
Internal Medicine.

Back pain is the leading cause of disability in people under age 45
globally, according to background information in the article. While it was
previously believed that “mechanical” problems such as degenerative disks
or arthritis caused the vast majority of back pain, “there’s a growing
realization that nerve-related pain accounts for a greater proportion of
people with back pain than was previously appreciated,” said Cohen, who is
also affiliated with Johns Hopkins University School of Medicine.

Like many other forms of pain involving the spine, sciatica is
notoriously difficult to treat, Cohen added.

Epidural steroids have been used to treat back pain for more than 50
years. There have been nearly 40 randomized, placebo-controlled trials —
the gold standard of research — trying to determine if steroids are
effective, Cohen said.

Even after decades of studies, there is still controversy over how
effective steroids really are and how long the relief lasts.

“Most people agree that epidural steroids are beneficial in people with
nerve-related back pain. Some people say it’s effective in the short term
but not long-term, or that it helps pain but doesn’t help function, or
that it helps pain but doesn’t decrease need for surgery,” Cohen said.

More recently, researchers have tried treating back pain with a newer
type of anti-inflammatory pain medication, etanercept, which is used to
treat rheumatoid arthritis and other autoimmune disorders.

In sciatica, it was previously believed that the pain emanated from a
degenerating disc that pressed on a nerve, but experts now believe that
the degenerating disc releases inflammatory molecules known as cytokines,
leading to inflammation and pain. Etanercept, a tumor necrosis factor
(TNF) inhibitor, blocks those cytokines.

Yet “the evidence doesn’t support use of epidural etanercept for
sciatica at this time,” said Dr. Roger Chou, who chaired the committee
that wrote the American Pain Society’s guidelines on treating lower back
pain.

In the study, 84 adults suffering with sciatica for less than six
months received two epidural injections, each two weeks apart, containing
either local anesthesia and saline, local anesthesia and steroids, or
etanercept. Patients who received epidural steroids received
transforaminal injections, a newer technique that studies suggest is more
effective but also carries a higher risk of complications, Cohen said.

At one month, about 75 percent of patients reported at least a 50
percent drop in leg pain after the steroid epidural. About 42 percent in
the etanercept group and 50 percent in the saline group reported similar
pain reductions.

At six months, slightly more of the saline group (40 percent) and
etanercept (38 percent) continued to have some pain relief, compared with
29 percent in the steroid group.

The study shows that “transforaminal epidural steroids might be
slightly better than epidural saline at short-term follow-up, but any
benefits are gone with longer-term follow-up,” said Chou, an associate
professor of general internal medicine at Oregon Health and Science
University, in Portland.

“The differences aren’t huge, averaging about one point on a 10-point
pain scale,” he said. “There weren’t any clear benefits from epidural
etanercept.”

Importantly, people got better no matter which intervention they
received, Chou added.

“I think it underscores our previous (APS) recommendation to consider
epidural steroids as a potential option for patients who are looking for
short-term pain relief, but to be very clear to patients that these
benefits do not appear to last and they have a good chance of improving
without the injection,” Chou said. “I think a lot of doctors (and
patients) think that epidural steroid injections are much more effective
(and longer lasting) than the evidence shows that they really are.”

Even though etanercept didn’t work great in this study, researchers say
it should continue to be studied for use with sciatica. People in the
study got a low dose of the drug, 4 milligrams (mgs), whereas people who
receive it for rheumatoid arthritis receive 25 mgs or 50 mgs. It’s
possible a higher dose would work better, Cohen said.

The bottom line is that better treatments for sciatica are sorely
needed, Cohen said.

Epidural injections of steroids can cause complications, including
paralysis and death.

Recommendations limit the number of injections people can get in a year
to decrease other side effects, including ulcers, immune-system
suppression, wound-healing interference and raising blood sugar levels in
diabetics, Cohen said.

More information

The U.S. National Library of Medicine has more on
sciatica.