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

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), pp. 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.

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More information

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

Identifiers

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

Catalogue record

Date deposited: 07 Apr 2006
Last modified: 17 Jul 2017 16:11

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Contributors

Author: N.K. Arden
Author: C. Price
Author: I. Reading
Author: J. Stubbing
Author: J. Hazelgrove
Author: C. Dunne
Author: M. Michel
Author: P. Rogers
Author: C. Cooper ORCID iD

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