Epidural Steroids, Saline and Etanercept vs. Sciatica

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Sciatica is a type of neurological pain that goes down the leg, normally below the knees, all the way to the shin, ankle or even down to toes. It is normally caused from inflammation in a spinal nerve root. Sciatica may occur from falls, sports injuries, motor vehicle accidents or any other accidents.

Sciatica is one of the most difficult pains to treat. Surgery was the only option to get relief from Sciatica but it is quite expensive and has a lot of complications. But a decade ago, a new approach to cure Sciatica was invented. A tiny amount of etanercept (almost one cubic centimeter) was found to be effective in reducing the pain. Etanercept is a newer type of anti-inflammatory pain medication which is normally used to treat rheumatoid arthritis and some other autoimmune disorders. They are basically injections containing saline along with a local anesthetic. But recently new research shows that epidural steroids are much better than Enbrel (etanercept).

Steroids vs. Enbrel

Though the differences were ‘modest’, it didn’t reach any statistical significance. Many patients complained that the pain came back after sometime and that steroids are no better than Enbrel. Dr. Steven Cohen, an anesthesia professor at Uniformed Services University of Health Sciences and also director of pain research at Walter Reed Army Medical Center, in Bethesda, said that they found strong suggestions regarding steroids being better than both Enbrel and injections containing saline and local anesthetic. He also said that most of the people suffering from back pain is from nerve-related problems as opposed to the previous belief, that is was caused by degenerative disks or arthritis. Below 45 years of age, back pain causes disability all over the world.

Epidural steroids to treat back pain?

Epidural steroids, for more than 50 years, have been put to use in the treatment of such back pain. Cohen also said that more than 40 placebo-controlled and randomized, trials have been made to see if the steroids are really effective but still there is controversy regarding the effectiveness and longevity of steroids.

Though earlier it was a common belief that the pain in sciatica normally occurred from degenerating disc when pressed on a nerve, nowadays experts believe that the pain and inflammation is caused by a type of molecules called cytokines that is released from the degenerating disc. These cytokines are blocked by etanercept.

Dr. Roger Chou, professor of General Internal Medicine at Oregon Health and Science University, in Portland, said that “transforaminal epidural steroids can be a little better than the epidural saline in case of short-term follow-up. However, any benefits are found gone with the longer-term follow-up”. He also mentioned that the differences are not much and that epidural etanercept had any clear benefits. The differences had an average of only one point on ten point scale he said.

The experiment

There was an experiment involving 84 adults who was suffering from sciatica to promote this statement. They were given two epidural injections, two weeks apart each that contained local anesthesia and steroids, local anesthesia and saline or Etanercept for less than six months. Transforaminal injections were given to patients who received epidural steroids as it is said to be more effective even that have higher complications. After one month, 42 percent in the etanercept group, 50 percent in the saline group and 75 percent in the epidural steroid group reported at least a drop of 50 percent in the leg pain. But after six months, only 29 percent in the steroid group continued to have pain relief as compare to 40 percent and 38 percent of the saline group and etanercept group respectively.

Chou said that it underscores their previous advices to take account of consider epidural steroids as one of the main options for all those patients who are trying to find out an effective and short-term relief from the pain. He also mentioned that these benefits become effective for a short period of time and patients have quite high chance of recovering without any injection.

Cohen concluded that though etanercept was not good in the experiments, it should be continued to experiment upon and given some more chance. He said that in case of rheumatoid arthritis, patients receive 25 mgs (milligrams) to 50 mgs whereas in case of sciatica, patients receive a low dose of only 4 mgs. Higher dose might actually prove more fruitful he said. The important thing is that we desperately need much better medications to treat sciatica.

Side effects

Injections usually have side effects and should be avoided as much as possible. Paralysis and sometimes even death can be caused by epidural steroid injections. If there is no other possibility then one should at least try to limit the usage of injections. The number of steroid injections a patient can use per year should be limited to a certain number so that side effects can be reduced. Some major side effects of steroid injections are immune-system suppression, raising blood sugar levels in diabetics, ulcers and wound-healing interference said Cohen.

Daryll Dykes who is the spokesman for the American Academy of Orthopedic Surgeons, though not involved with the study, said that many people who have back pain normally tend to heal by themselves without any treatment. But for people who are suffering from such pain, it is very much important to know that there are studies going on different options. He also said that some people can even herniated a disc by rolling over in bed in a wrong way, some might even do it during sneezing and in some cases genes may even play a role.

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