[Epidural injection shows no advantages over oral medication and physiotherapy in the treatment of sciatica, irrespective of the duration of symptoms].

Abstract

BACKGROUND:

The study presented here investigated the short-term effectiveness of one-off lumbar caudal epidural injection (EI) in sciatica in relationship to the reported duration of pain.

MATERIALS AND METHODS:

This retrospective analysis involved 106 consecutive in-patients who received either conservative treatment (Group I) or an additional EI on the first day of their treatment (Group II). Both groups were divided according to the duration of symptoms at the time of admission (less than three months, or more than six months). Propensity score matching was performed for the whole collective and the resulting subgroups. This incorporated gender, age and pain intensity at the time of admission. The target parameter were changes on a visual analogue scale (VAS) of pain intensity on days D1, D3, and D10 depending on the respective treatment. A routine evaluation of the mental variables anxiety, depression and somatisation was performed as part of the examination upon admission and their relationship to the success of treatment was later assessed.

RESULTS:

The mean age of the patients was 61.7 (± 11.6) in Group I and 63.6 (± 13.6) in Group II. 59 % of the patients were female (n = 63). The Lasègue sign was prevalent in 45 % of Group I and 51 % of Group II. The intensity of pain on the day of admission was similar in both groups (7.0 ± 1.0 for Group I, 6.7 ± 1.8 for Group II). The length of stay on the ward was also similar in both groups (10.2 ± 3.9 and 9.4 ± 3.7 d, respectively). It was found that, independent of the duration of symptoms, injection treatment was significantly more effective than conservative treatment only in the early stages (D1 and D3, p < 0.001). No differences could be found in the expression of these mental variables between treatment groups, as these factors showed no influence on the results of therapy.

CONCLUSIONS:

In the context of acute treatment a once only lumbar caudal epidural injection represents at most a short-term effectiveness for the therapy of sciatica. The results presented here indicate that neither the duration of symptoms nor the measured psychometric variables show any effect on the success of therapy.

• Authors: K E Roth, M Kremer, G S Maier, M Sariyar, J-D Rompe, B Kappis
• Journal: Zeitschrift fur Orthopadie und Unfallchirurgie (Z Orthop Unfall) Vol. 152 Issue 1 Pg. 46-52 (Feb 2014) ISSN: 1864-6743 [Electronic] Germany
• Vernacular Title: Kein Vorteil der epiduralen Injektion vs. oraler Medikation und Physiotherapie bei Ischialgie, unabhängig von der Beschwerdedauer.
• PMID: 24578114 (Publication Type: English Abstract, Journal Article)
• Copyright: Georg Thieme Verlag KG Stuttgart · New York.

Chemical References

• Analgesics
• Anesthetics, Local
• Bupivacaine

Topics

• Administration, Oral
• Analgesics (administration & dosage)
• Anesthetics, Local (administration & dosage)
• Bupivacaine (administration & dosage)
• Female
• Humans
• Injections, Epidural (methods)
• Male
• Middle Aged
• Pain Measurement
• Physical Therapy Modalities
• Retrospective Studies
• Sciatica (therapy)
• Treatment Outcome