SAN ANTONIO — A single, intravenous injection of methylprednisolone performed just slightly better than placebo in alleviating pain from acute discogenic sciatica, Axel Finckh, M.D., said at the annual meeting of the American College of Rheumatology.
Dr. Finckh presented a study in which 59 patients with radiographically confirmed discogenic sciatica were randomized to either a single, 500-mg, intravenous bolus of methylprednisolone or to placebo, and then followed for 10 days.
Both groups had significant improvement in pain on the first day, as shown with a 100-point, visual analog scale, with a greater mean improvement for the methylprednisolone group.
However, mean scores in both groups were about the same by the third day and remained comparable through day 10.
Both groups had gradual diminishment of pain from day 3 onward, said Dr. Finckh, of Brigham and Women's Hospital, Boston.
Nor were response rates significantly different on a straight leg test for radicular irritation, a McGill Pain Score for global pain, a flexibility score, and a functional disability questionnaire, Dr. Finckh explained.
The patients in the study had all had sciatica for at least 1 week, and not more than 6 weeks, prior to being treated.
Use of nonsteroidal anti-inflammatory drugs was permitted.
The use of corticosteroids in sciatica is controversial, Dr. Finckh said.
Most studies of oral administration have not demonstrated any benefit.
Some studies of epidural administration, however, have shown positive findings.
His group conducted the study because they hypothesized that giving the corticosteroid intravenously might be a way to achieve high drug levels quickly, without the risks and pain typically associated with epidural administration.
Despite the negative results, Dr. Finckh seemed unwilling to give up completely on intravenous injection for sciatica.
He noted that 48% of the steroid-treated patients had pain improvement, versus 28% of the placebo patients.
Long-term treatment using the technique might have more of an effect, he said.