Dexamethasone is not superior to placebo for treating lumbosacral radicular pain

Abstract

In a prospective double-blind study, we compared dexamethasone and placebo in 33 subjects with lumbosacral radicular pain. Of subjects with resting pain, 7/21 improved on dexamethasone, and 4/12 improved on placebo. Of subjects with pain on straight-leg raising, 8/19 improved on dexamethasone and 1/6 on placebo. Of 27 subjects evaluated 1 to 4 years after treatment, 8/16 who had received dexamethasone were asymptomatic or had only occasional mild low-back pain, compared with 7/11 who had received placebo. Thus, dexamethasone is not superior to placebo for either early or long-term relief of lumbosacral radicular pain, but may reduce pain evoked by stretch of acutely inflamed spinal nerve roots.

Oral Steroids in Initial Treatment of Acute Sciatica

“…Patients who received prednisone also required fewer epidural injections than did members of the control group. Our study confirms, in a contemporary outpatient setting, as Haimovic's study 15 did with hospitalized patients 20 years ago, that there are no dramatic results to be gained from treating acute sciatica with oral steroids. However, patients in our study who received prednisone experienced statistically significant, although subtle, improvements that should not be discounted.…”

“…13 Studies of patients who have sustained injury to the spinal cord or nerve roots suggest that pain and disability result from a complex interplay between local inflammatory responses and neurohumeral interaction between the brain, spinal cord, and nerve roots. [13][14][15] Steroid agents are known to reduce tissue damage by stabilizing cell membranes, reducing capillary permeability, and limiting release of proinflammatory substances. 13 Based on this knowledge, it has become relatively common for primary care physicians to treat acute sciatica with a course of oral steroids, although there is little clinical evidence to support this practice.…”

“…13 Based on this knowledge, it has become relatively common for primary care physicians to treat acute sciatica with a course of oral steroids, although there is little clinical evidence to support this practice. 6,15 Literature searches using PUBMED and MEDLINE pro-duced only one blinded, randomized, controlled study that addressed this issue. 15 In that study, performed in the 1980s, all patients were hospitalized and put on bed rest for 1 week.…”

“…6,15 Literature searches using PUBMED and MEDLINE pro-duced only one blinded, randomized, controlled study that addressed this issue. 15 In that study, performed in the 1980s, all patients were hospitalized and put on bed rest for 1 week. The study group received a 7-day tapering dose of oral dexamethasone, which was observed to be no better than placebo for treating sciatic pain.…”

“…The study group received a 7-day tapering dose of oral dexamethasone, which was observed to be no better than placebo for treating sciatic pain. 15 Other studies have shown mixed, but generally positive, shortterm results from treatment of sciatica using epidural injection of steroid agents. 2,6,8,12,16 -21 Contemporary treatment of acute sciatica occurs almost exclusively in the outpatient arena.…”