Epidural Steroids Injections: Why Are They Not A Primary Treatment For Sciatica?

Epidural steroid injections are not the first option tried when a patient presents with sciatica. This can lead to some confusion. Patients may fear that the procedure is not wholly safe, after all, if it were completely safe, then why wasn’t it tried weeks ago? Or they may be annoyed that they have had to wait for this treatment to be offered after a few weeks of pain, so they feel that it should be the first option for sciatica. This article looks at why epidural steroid injections are not the first treatment option for sciatica and when it is considered to be a viable treatment.

Are Epidural Steroid Injections Safe?

Epidural steroid injections are actually very safe, since they are simply an injection that contains both local anaesthetic and steroids. In effect these reduce the inflammation that is causing pain in the nerves and the disc in the spin and the local anaesthetic numbs the area, bringing short term numbness to the region. By the time the local anaesthetic wears off the steroid will be working to reduce inflammation.
However there are some risks with the procedure, but these need to be looked at in context. Almost every human activity carries some risk with it. For example, crossing the road, lifting heavy objects, even opening a tin of beans all carry risks. Yet we do them every day, simply because they are necessary to human function.
There are some very low risks of infection (these risks are slightly higher if the patient is diabetic).
There is also a risk that in only about 1-2% of cases the membrane that covers the spinal cord is punctured. This usually requires no treatment and can be resolved with the patient simply being monitored.
Very rarely patients may find that the condition is not eased by the injection, so it is not successful or in a very, very rare case, the needle used to deliver the injection can actually damage the nerves. But this is actually extremely rare.
Sometimes patients can have an allergic reaction to the dye that is used to guide the needle but this is not a serious allergy.
In effect it is a safe procedure.

Why Wait For Epidural Steroid Injections?

Like any field of medicine any option that carries no risks will be the preferred options to try. Sciatica often flares up and then it goes away again on its own, so it is better to try and wait and see if it will resolve itself, rather than embark on a procedure that carries even very low levels of risk.
Epidural steroid injections are therefore used when there is little response to traditional treatment options and the pain is showing no level of subsiding. Patients may be advised to wait several weeks after the sciatica presents, before the injections are suggested, but it depends on the individual patient and the levels of pain that are experienced.
Patients have nothing to fear from epidural steroid injections but given that sciatica can resolve itself without intervention, this is the most favourable treatment initially. Then if this is not successful, the injections offer a very safe and effective means of treatment.

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