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Posted on 09-07-2011

Morning Folks!

Came across the below study from the European Spine Journal (dated 09/04/2011).  This study clearly shows that for your friends, family, and co-workers suffering from "sciatica" from low back nerves going down the leg (particularly to the foot) that epidural steroid injections (ESI) are beneficial for pain but NOT for dysfunction resulting in disability.   I have advocated for years that motion is life and without it leads to degenerative diseases and ultimately death.  ESI, just like medications are great for giving relief but never really fix the problem.  Think about it, when you have a headache...it is not from a lack of Tylenol.  There is a malfunction with the nerves or blood vessels in the body causing the headache.  Tylenol masks is and if you are lucky enough to give yourself relief long enough for the joint to calm down then you are good.  We find most of the time your body finishes with the drug and the pain and/or headaches come back.  

The scary thing I have witnessed as a Qualified Medical Evaluator for the Division of Workers' Compensation is these epidurals can last anywhere from hours to years.  And there is no way of predicting how long it will last.  This in my opinion is unacceptable as there are considerable risks associated with administering a corticosteroid into your spinal canal; not to mention the risk of a "wet tap" or infection at the needle site exposing you to risk of meningitis.  ESI should be used as a last resort just prior to surgery which has its own problems (Google: Failed Back Surgery Syndrome - yes there is a diagnosis named that!). 

In our office we use a variety of healing methods that harness the body's own innate healing abilities to cure itself.  We have found a combination of Chiropractic, Acupuncture, and Massage are dynamite at taking care of both acute and chronic pain AND improving your function (e.g. improved golf, picking up the kids, prolonged sitting at work, etc.)  Give our office a call @ 243-9464 if you are suffering from pain and sick of the medications.  The research speaks for itself. Here is the article:

Eur Spine J. 2011 Sep 4. [Epub ahead of print]

Transforaminal injection of corticosteroids for lumbar radiculopathy: systematic review and meta-analysis.

Source

Centre for Spine Studies and Surgery, Queens Medical Centre, West Block, D Floor, Derby Road, Nottingham, NG7 2UH, UK, nasquraishi@hotmail.com.

Abstract

BACKGROUND:

Transforaminal epidural injection of steroids is used to treat lumbar radicular pain. However, there are only a few well-designed randomized, controlled studies on the effectiveness of steroid injection.

STUDY DESIGN:

Hence, this study aims to assess the effectiveness of steroid injection to treat lumbar radicular pain using a meta-analysis of transforaminal epidural injection therapy for low back and lumbar radicular pain. The comparison was based on the mean difference in the Visual Analogue Score (VAS) and Oswestry Disability Index (ODI) from baseline to the specified followed up.

METHODS:

The available literature of lumbar transforaminal epidural injections in managing low back and radicular pain was reviewed. Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE from 1966 to 2009, and manual searches of the bibliographies of known primary and review articles. Finally, the search included the Current Controlled Trials Register and the Cochrane Database of Controlled Trials.

RESULTS:

The initial search identified 126 papers. After screening, five randomised controlled trials (RCTs) were studied for analysis and only three of these had followed-up patients systematically with pain and disability outcome scores to 3 months and of these, only one had follow up to 12 months. A total of 187 patients ('treatment group' receiving local anaesthetic/steroid injection) were compared with 181 patients ('control' group, receiving local anaesthetic only or saline injection). Improvement in pain (standardised mean difference in VAS 0.2 in favour of 'treatment'; 95%CI: -0.41 to 0.00, p = 0.05, I squared 0%) but not disability (standardised mean difference in ODI 0; 95%CI: -0.21 to 0.20, p = 0.99, I squared 0%) was observed between 'treatment' and 'control' groups; these differences were not significant. Additionally, the one study following patients to 12 months did not find any significant difference in VAS and ODI between treatment and control groups.

CONCLUSION:

The current meta-analysis shows that transforaminal epidural steroid injections, when appropriately performed, should result in an improvement in pain, but not disability. The three RCTs that followed patients to 3 months (and the single study to 12 months) have found no benefit by the addition of steroids

Have a blessed day! 

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