Nov 15, 2008

Sciatica and the Saline Story

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Could saline solution be the magic cure for sciatica and other forms of radiculopathy?

I don't know. Maybe it's a dumb question.

But one thing is certain. It has been used in research studies to effectively treat sciatica with the same success rate as epidural steroid injections.

What's The Deal?

If you've read my series on epidural injections, then you know that at one time I was skeptical of their use for the treatment of sciatica. There were several reasons for this not the least of which was a research study that appeared back in 2003 that seemed to cast steroids in a bad light.

Here's what an article written about that study had to say:

"July 1, 2003 - Steroid epidural injections are no better than saline epidural injections for sciatica, based on the results of a randomized, double-blind trial published in the June issue of the Annals of Rheumatic Diseases." [1]

At that point -- because I wasn't very interested in steroids to begin with -- I decided there was no reason to waste any more time on them and moved on to other topics.

It wasn't until years later that I would find myself revisiting the subject with fresh eyes and a bit more interest than before. This time I wanted to find out as much as I could about steroid injections and whether or not they could in fact play a role in helping people rebuild their backs.

So naturally, as I was gathering reference materials, I went back and dug up that old research article and took another look at it.

Here are some of the highlights:

"In this study, 85 patients with sciatica lasting 15 to 180 days thought to be caused by disk herniation received three epidural injections, at two-day intervals, of 2 mL prednisolone acetate (50 mg) or 2 mL isotonic saline." [1]

(In other words, half of the patients got the steroid and half received saline solution.)

"Treatment success was defined as recovery or marked improvement on self-evaluation scales at day 20..." [1]

And the results were...

"At the end of the study (day 35), 49% of treatment patients and 48% of control patients were in the "success" group..." [1]

Isn't that interesting? There was a fifty percent success rate in both groups.

What This Study Does Not Show Us:

Despite my earlier dismissal of steroid injections, a closer examination makes it clear that this study did not prove that epidural steroid injections were not effective.

All it really demonstrated was that something else (saline solution) was also effective at relieving the symptoms of sciatic nerve pain.

What This Study Does Show Us:

Rather than casting steroid injections in a bad light, what this study actually seems to be telling us is that both treatments produced the same success rate.

"The efficacy of isotonic saline administered epidurally for sciatica cannot be excluded…" [2]

"Epidural saline injection for pain control in sciatica may or may not be efficacious." [2]

This raises some very interesting questions:

Why were saline injections successful?

Is there a role for saline injections in treating sciatica?

Could saline injections (given either prior to, or post) enhance the results from steroid injections?

Since we know that some people are not candidates for steroid injections, perhaps they would respond favorably to epidural saline injections?

This might be worth asking your doctor about.

As always,
Dean

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About the Author

Dean Moyer is the author of the books, Rebuild Your Back, Rebuild Your Neck and The Pain Relief Manual. Copies of his books are available exclusively through this website. Read more...

Rebuild Your Back
Rebuild Your Back
Second Edition
Rebuild Your Neck
Rebuild Your Neck
The Pain Relief Manual
The Pain Relief Manual

References:

1. Steroid No Better Than Saline Epidural Injections for Sciatica - Medscape

2. Valat, JP, et al. Epidural corticosteroid injections for sciatica: a randomised, double blind, controlled clinical trial. Ann Rheum Dis. 2003 Jul;62(7):639-643.