Injections of arthritis drugs or steroids in the spine may not do much to help patients with chronic back and leg pain due to nerve damage, according to a new study. Though there were some initial safety concerns about the injections, the study didn´t show an increased risk of infections or other complications. Researchers said the anti-arthritis drug etanercept (sold as Enbrel) may better serve its patients when taken in larger doses, or when taken on an as-needed basis. Enbrel has been prescribed to patients with severe nerve damage, resulting in chronic back and leg pain.
In a report in the Annals of Internal Medicine, the researchers say they couldn´t definitively say whether or not either type of injection would help people with such nerve-related chronic pain. “This kind of pain is very challenging to treat. There´s no reliable treatment that works in everyone,” said Dr. Steven Cohen from the Johns Hopkins University School of Medicine in Baltimore, according to Reuters.
Speaking to Reuters Health, Dr. Cohen said medications do not tend to work very well. Dr. Cohen also said surgeries may offer short term relief, but there was no difference in patients who did and did not have the surgery a few years later.
This back and leg pain due to nerve damage is known as sciata, and until now, patients with sciata have been treated with epidural steroid injections, according to Dr. Cohen. Lately, however, more and more patients have been looking to injections of immune suppressing drugs like Enbrel.
“People are looking for something more effective and something safer,” he said. “The findings are disappointing, but by no means is this the end of the story.”
To conduct his study, Cohen tracked 81 patients in their early 40s for at least one month. These patients were treated at one of four military medical centers and two civilian hospitals.
Cohen then split these patients into three groups. Each group was given a different type of injection: A steroid called methylprednisolone, Enbrel or a saline solution. Neither the patients nor the doctors knew which group was receiving which injection.
When patients checked in a month later, their results were unanimous across the board. Each patient reported similar reduction in back and leg pain, despite which injection they received. Those patients who received saline solutions, however, reported larger improvements in their ability to move around than those who had received the steroid and Enbrel injections.
Dr. Cohen said he was disappointed by the lack of any significant benefit from receiving the Enbrel injections as opposed to a simple saline solution.
“These drugs are expensive, and even though they may be safer than steroids, they´re not devoid of risk,” he said.
Listed anywhere from $500-$700, the steroid and Enbrel injections are not cheap. According to Dr. Cohen, the biggest concern of the Enbrel injections are immune system side effects, while the steroid injections can increase blood sugar levels as well as cause stomach problems.
Dr. Cohen suggests a patient´s behaviors and lifestyle could end up playing a larger role in their sciata treatment.
“The treatment that has the strongest evidence behind it is actually exercise programs,” he said – “as well as losing weight, for people who are too heavy.”