Why don’t steroid injections always work for sciatica?

Have a sharp pain that goes from your butt down to your knee or ankle? Most people know what sciatica is but many do not know or understand why that have it or why some therapies do nothing to help with the pain long-term. Which begs the question I often get in my practice, is “Why don’t steroid injections always work for sciatica?”

What is sciatica?

Sciatica refers to pain, weakness, numbness, or tingling in the glute/upper leg, and even lower leg. It is caused by injury to or pressure on the sciatic nerve. Sciatica is a symptom of a medical problem. About 90% of sciatica cases are caused by spinal disc issues that may compress the sciatic nerve roots. This protrusion of lumbar disks, could cause “sciatic like pains” but you may also get similar symptoms with issues affecting the muscles of your lower back and glutes, infections, and even spinal stenosis in the lumbar or gluteal region. These causes can also lead to inflammation of the sciatic nerve. About 85% of patients suffering from sciatica also have disc disorders, so their pain is due to both mechanical injury and inflammatory factors.

Sciatica is mainly diagnosed with a history of pain distribution and radiation below the knee, and with neurological tests indicating neurological deficit or nerve root tension. However, there are no diagnostic items or tests to really diagnosis sciatica specifically, yet tests may find possible causes of why the nerve is irritated such as listed above. Therefore, sciatica is a symptom and the goal should be to find the cause and treat it.

Standard Options for treatment:

Most people go to their PCP to get help with sciatica. The first option is a conservative approach using non-steroidal anti-inflammatory drugs (NSAIDs), or muscle relaxers, some cases opioids, and even corticosteroids to try and help calm inflammation and reduce pain. Often they are referred to physical therapy and if they “fail” a course of care, are referred to surgeon to see if surgery is indicated. The medical may help with symptoms, however, they have provided limited pain relief and have been often accompanied by adverse effects of dizziness, drowsiness, allergic reactions, and digestive upset. The second option is an invasive approach (surgery).

One option given to patients with sciatica is a steroid injection. Epidural steroid injections have been found to provide possible benefit for nerve issues related to a herniated disc and degenerative disc disease. Spinal injections do nothing to correct the problem that is the root cause of your pain.

The injection is simply blocking the mechanism that delivers the pain message to your brain or temporarily reducing inflammation. But it is doing nothing to fix the problem that is actually causing the pain and inflammation. 

The best analogy is: if your check engine light comes on in your car, how do you fix it? Do you cut the wire so that the light turns off? Or do you determine what the problem is that caused the light to come on and fix that problem? Until you fix the cause of the pain, it will come back.

Why is sciatica so difficult to treat?

What makes sciatica symptoms complicated is that there may be several different issues going on at once and treating one issue will not effectively reduce symptoms. Did you know that back pain can come from muscle areas of the back? Steroid injections work to reduce inflammation but studies have found that if the primary cause of the pain is a fracture, arthritis, or muscle strain, the effectiveness of the steroid injection is uncertain and could be why some do not respond to steroid injections. 

Patients are more likely to choose surgery over conservative treatments because of earlier pain relief. However, few benefits exist in pain relief or functional improvement one year after surgery compared with conservative treatments.

Side effects of epidural steroid injections should be considered if choosing that route for pain relief. Studies have found that steroid injections can put you at risk for osteoporosis, weakened bones or ligaments, water retention, and immune suppression. There is a reason why you can only get so many steriod injections. 

How can acupuncture help?

If you really look at the research. There are more current studies about how acupuncture can help sciatica than how steroid injections can help sciatica, long-term. In a recent study which reviewed over 28 studies and over 2000 patient showed acupuncture was more effective and safer than analgesics for sciatica. The reason why acupuncture works so well is that it can address multiple causes of why you have sciatica pain. Acupuncture can help with calming nerve inflammation, reduce muscle spasms by increasing blood flow to the area, helps to heal any damage or irritation, in addition to help improve function and decrease pain. It has also been found to be very safe and effective. 

If you suffer from chronic low back pain or sciatica and not finding relief, give our office a call at (425) 686-4498 to set-up your initial consultation to learn how we can help. 

Dr. Ellie Heintze, ND, LAc, is a naturopathic doctor and acupuncturist in Bothell, WA at her practice Starting Point Acupuncture. She specializes in chronic and complex cases and commonly treats neuropathy, fibromyalgia, migraines, autoimmune, and infertility cases. Dr. Ellie Heintze is also the author of the book, A Starting Point Guide to Going Gluten-Free  and Keep Calm and Zen Out available on Amazon.

Sources:

https://health.clevelandclinic.org/why-dont-steroid-injections-help-my-back-pain/

Shows only short-term or no improvement in sciatica vs placebo:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376799/

Acupuncture and sciatica:

https://www.sciencedirect.com/science/article/pii/S0965229922000747

https://academic.oup.com/painmedicine/article/20/11/2303/5542683

https://www.reuters.com/article/us-spinal-steroid/spinal-steroid-shots-may-have-little-effect-on-sciatica-idINBRE8AB19L20121112

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575738/

https://www.sciencedirect.com/topics/medicine-and-dentistry/lumbar-disk