Treatment for Sciatic Pain

     I recently came across an article about the use of epidural steroid injections for sciatic pain.  The study analyzed the results from two dozen clinical trials on thousands of patients.  The study concluded that "epidural injections (into the spine) of corticosteroids had no long- or short-term effect on sciatica back pain, and such a small short-term effect on leg pain it would make no difference to the patient." A link to this article can be found here.

     To be honest, I have mixed feelings about this one.  I have been using pain management doctors for many years to help my patients who can not seem to get their inflammation under control.  Like any procedure, the effectiveness is dependent on many different factors.  Better candidates experience better results.  I understand that the injection itself does nothing to correct the physical problem that is the cause of the sciatic pain.  Instead, the steroid simply extinguishes the inflammation temporarily.  This explains why there seems to be some good short-term relief but no real gains in the long run.  For this reason, in my practice, I tend to utilize epidural injections for that short-term pain reduction so that I can get some work done in an effort to make some structural changes that will treat the cause of the irritation to the sciatic nerve, rather than just treating the outcome.  This can be achieved through spinal manipulation, spinal decompression, physical therapy modalities, and rehabilitation.  I have had really great results co-managing patients this way.  The pain management doctor helps the patient with their pain in the short-term while I offer non-surgical treatment that addresses the cause of the patient's sciatic pain.

     I hope that other physicians who read the article continue to educate themselves on the treatments available for their patients who suffer with sciatic pain.  I sincerely believe that all treatment options should be utilized before surgery is considered.  Given the high success rate of spinal decompression and chiropractic care for patients with back pain and sciatic pain, I think that these treatment methods should always be considered before more invasive procedures are carried out.