Sciatic Pain Relief with Pulsed Radiofrequency and Steroid Injections

Sciatica is a painful condition in which the sciatic nerve, which runs from the lower back down through the buttocks and into the legs, becomes irritated or compressed. This often happens due to a herniated disk, bone spur, or spinal stenosis. The hallmark symptom is sharp, shooting pain that radiates from the lower back or buttocks down one leg. It can be accompanied by tingling, numbness, or weakness in the affected leg. Sciatica can severely impact daily activities and quality of life. Treatment options range from rest and physical therapy to medications and, in some cases, surgery, depending on the underlying cause and severity. Effective non-surgical management of sciatica is a pressing challenge in healthcare.

Clinical Trial

A clinical trial assessed the effectiveness of a combined treatment approach involving pulsed radiofrequency (PRF) and transforaminal epidural steroid injection (TFESI) compared to TFESI alone in alleviating sciatic pain due to long-standing lumbar disk herniation. This trial included participants suffering from sciatica due to lumbar disk herniation that had persisted for at least 12 weeks and was unresponsive to conservative treatments. The participants, totaling 351 individuals (223 men), were randomly assigned to one of two groups: combined PRF and TFESI treatment (174 participants) or TFESI alone (177 participants).

The primary outcome measure was the severity of leg pain, assessed using the numeric rating scale (NRS) with a range of 0-10. Evaluations were conducted at weeks 1 and 52 after treatment. Secondary outcomes included scores from the Roland-Morris Disability Questionnaire (RMDQ) and the Oswestry Disability Index (ODI), which assess disability levels.

Results

Both groups had similar NRS scores at baseline, indicating similar pain levels. However, significant differences emerged post-treatment. At week 1, the NRS score dropped to 3.2 ± 0.2 in the PRF and TFESI group, while it remained at 5.4 ± 0.2 in the TFESI group. This represented a notable average treatment effect of 2.3 in favor of the combined PRF and TFESI group. At week 52, the NRS scores were 1.0 ± 0.2 in the PRF and TFESI group and 3.9 ± 0.2 in the TFESI group, with an average treatment effect of 3.0.

Additionally, at week 52, the average treatment effect for ODI was 11.0; for RMDQ, it was 2.9, favoring the combined PRF and TFESI group. Adverse events were reported in 6% of participants in the PRF and TFESI group and 3% in the TFESI group, with no severe adverse events recorded.

Conclusion

In treating sciatica caused by lumbar disk herniation, combining pulsed radiofrequency with transforaminal epidural steroid injection proved more effective in pain relief and disability improvement than steroid injection alone. This study provides valuable insights into a promising approach for managing long-standing sciatic pain, offering hope to individuals seeking non-surgical solutions for their condition.
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