Back

Predicting Results of Epidural Injections for Sciatica

Doctors know that epidural injections help some patients with mild to moderate sciatica pain. The cause of the pain is usually from a herniated disc. Medicine is injected into the epidural space within the spinal column, around the spinal cord. It would be helpful to know which patients will get relief of pain with this treatment. Are results based on age? Gender? Lifting? Pain medications? Social Security disability? workers' compensation? These are some of the factors researchers at the University of Michigan Spine Program looked at as predictors of results.

They reviewed the charts of 76 patients. All patients had studies done to show that a disc pressing on a spinal nerve root was the cause of their pain. Imaging studies pinpointed the location of the problem so that an injection could be given at that site.

Patients were rated as better, same, or worse in terms of pain and function. Age, height, weight, and gender didn't seem to make any difference in results. The two major predictors of outcomes were heavy lifting and getting Social Security Disability Insurance (SSDI) or workers' compensation (WC). In this study, patients with heavy lifting, SSDI, or WC didn't get better after getting an injection. They had just as much pain and needed just as much medication. Patients who were working when they first came for treatment tended to have a better result. Injections also seemed to have better results when it was clear that there was pressure on the spinal nerve.

The authors report that this is the first study to link physical demands of the job with poor results after injection for sciatica. They suggest using injections for patients who don't have SSDI or WC and who don't have a job that requires heavy lifting. An epidural injection for these patients may have a better chance of lessening pain and reducing the need for drugs.

The authors conclude these are just two factors to use when deciding treatment for sciatica. More studies are needed to narrow down who can and can't benefit from epidural injections. Patients who aren't likely to get better with injections can avoid the risks that come with this form of treatment.

References: Henry C. Tong, MD, et al. Predicting Outcomes of Transforaminal Epidural Injections for Sciatica. In The Spine Journal. November/December 2003. Vol. 3. No. 6. Pp. 430-434.

Back