The University of Southampton
University of Southampton Institutional Repository

A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: the WEST study

A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: the WEST study
A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: the WEST study
Objective. To determine the effectiveness and predictors of response to lumbar epidural corticosteroid injections (ESI) in patients with sciatica. We performed a 12-month, multicentre, double-blind, randomized, placebo-controlled, parallel-group trial in four secondary pain-care clinics in the Wessex Region.
Methods. Two hundred and twenty-eight patients with a clinical diagnosis of unilateral sciatica of 1–18 months’ duration were randomized to either three lumbar ESIs of triamcinolone acetonide or interligamentous saline injections at intervals of 3 weeks. The main outcome measure was the Oswestry low back pain disability questionnaire (ODQ).
Results. At 3 weeks, the ESI group demonstrated a transient benefit over the placebo group (patients achieving a 75% improvement in ODQ, 12.5 vs 3.7%; number needed to treat, 11.4). No benefit was demonstrated from 6 to 52 weeks. ESIs did not improve physical function, hasten return to work or reduce the need for surgery. There was no benefit of repeated ESIs over single injection. No clinical predictors of response were found. At the end of the study the majority of patients still had significant pain and disability regardless of intervention.
Conclusions. In this pragmatic study, ESIs offered transient benefit in symptoms at 3 weeks in patients with sciatica, but no sustained benefits in terms of pain, function or need for surgery. Sciatica is a chronic condition requiring a multidisciplinary approach. To fully investigate the value of ESIs, they need to be evaluated as part of a multidisciplinary approach.
sciatica, epidural injection, corticosteroids, pain, surgery
1462-0324
1399-1406
Arden, N.K.
23af958d-835c-4d79-be54-4bbe4c68077f
Price, C.
534dbc54-63be-46a7-8394-479a4e1dc22d
Reading, I.
6f832276-87b7-4a76-a9ed-b4b3df0a3f66
Stubbing, J.
82f2ca29-85fa-415f-aa0a-eae6d7aebbdf
Hazelgrove, J.
96c6dc82-e221-4ed2-b8a8-ab5bc94458e5
Dunne, C.
96e618b0-df8d-4f46-841f-8d76d138c447
Michel, M.
560e6263-d080-4126-827a-8ad1b36764d4
Rogers, P.
0b9c2fba-91c2-417a-a1ea-4d84a3f6882a
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Arden, N.K.
23af958d-835c-4d79-be54-4bbe4c68077f
Price, C.
534dbc54-63be-46a7-8394-479a4e1dc22d
Reading, I.
6f832276-87b7-4a76-a9ed-b4b3df0a3f66
Stubbing, J.
82f2ca29-85fa-415f-aa0a-eae6d7aebbdf
Hazelgrove, J.
96c6dc82-e221-4ed2-b8a8-ab5bc94458e5
Dunne, C.
96e618b0-df8d-4f46-841f-8d76d138c447
Michel, M.
560e6263-d080-4126-827a-8ad1b36764d4
Rogers, P.
0b9c2fba-91c2-417a-a1ea-4d84a3f6882a
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6

Arden, N.K., Price, C., Reading, I., Stubbing, J., Hazelgrove, J., Dunne, C., Michel, M., Rogers, P. and Cooper, C. (2005) A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: the WEST study. Rheumatology, 44 (11), 1399-1406. (doi:10.1093/rheumatology/kei028).

Record type: Article

Abstract

Objective. To determine the effectiveness and predictors of response to lumbar epidural corticosteroid injections (ESI) in patients with sciatica. We performed a 12-month, multicentre, double-blind, randomized, placebo-controlled, parallel-group trial in four secondary pain-care clinics in the Wessex Region.
Methods. Two hundred and twenty-eight patients with a clinical diagnosis of unilateral sciatica of 1–18 months’ duration were randomized to either three lumbar ESIs of triamcinolone acetonide or interligamentous saline injections at intervals of 3 weeks. The main outcome measure was the Oswestry low back pain disability questionnaire (ODQ).
Results. At 3 weeks, the ESI group demonstrated a transient benefit over the placebo group (patients achieving a 75% improvement in ODQ, 12.5 vs 3.7%; number needed to treat, 11.4). No benefit was demonstrated from 6 to 52 weeks. ESIs did not improve physical function, hasten return to work or reduce the need for surgery. There was no benefit of repeated ESIs over single injection. No clinical predictors of response were found. At the end of the study the majority of patients still had significant pain and disability regardless of intervention.
Conclusions. In this pragmatic study, ESIs offered transient benefit in symptoms at 3 weeks in patients with sciatica, but no sustained benefits in terms of pain, function or need for surgery. Sciatica is a chronic condition requiring a multidisciplinary approach. To fully investigate the value of ESIs, they need to be evaluated as part of a multidisciplinary approach.

Full text not available from this repository.

More information

Published date: 2005
Keywords: sciatica, epidural injection, corticosteroids, pain, surgery

Identifiers

Local EPrints ID: 25204
URI: https://eprints.soton.ac.uk/id/eprint/25204
ISSN: 1462-0324
PURE UUID: bd427f06-06b2-4ee9-89f4-5008f2ad27ec
ORCID for I. Reading: ORCID iD orcid.org/0000-0002-1457-6532
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 07 Apr 2006
Last modified: 10 May 2019 00:36

Export record

Altmetrics

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of https://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×