Oral Steroids in Initial Treatment of Acute Sciatica

Abstract

Objective: Many physicians use prednisone to treat acute sciatica with the hope of speeding recovery. There is little clinical evidence to support this practice. Our objective was to determine whether early administration of oral prednisone affects parameters related to recovery from acute sciatica.Methods: In this double-blind, controlled clinical trial, 27 patients were sequentially assigned to receive either a 9-day tapering course of prednisone (n ‫؍‬ 13) or placebo (n ‫؍‬ 14) within 1 week of developing sciatic symptoms. Patients and investigators were blinded to the drug administered. Follow-up assessment was done weekly for 1 month and then monthly for 5 months.Results: Prednisone and control groups showed no statistically significant differences in physical findings, use of nonsteroidal anti-inflammatory drugs or narcotic medications, or rates of patients returning to work at any time interval studied. Compared with controls, patients who received prednisone had more rapid rates of improvement from baseline in pain, mental well-being, and disability scores. These changes were subtle but statistically significant. Patients who received prednisone tended to receive fewer epidural injections for pain.Conclusions: Early administration of oral steroid medication in patients with acute sciatica had no significant effect on most parameters studied. It did, however, lead to slightly more rapid rates of improvement in pain, mental well-being, and disability scores. The impact of oral steroids on other outcomes is suggested by this study, but its small sample size limited its statistical power. Sciatica (lumbosacral radiculopathy) is a common problem seen by primary care physicians and is diagnosed in approximately 1% of all patients who present with acute low back pain.1,2 Traditional treatment includes pain medication (acetaminophen, nonsteroidal anti-inflammatory agents [NSAIDs], or narcotic agents); activity as tolerated; and time. 1,[3][4][5][6][7][8] Patients with intractable pain or progressive neurologic symptoms usually receive an epidural injection of steroid drugs and, if necessary, decompressive laminectomy or diskectomy. 2,8,9 Fifty percent of patients with sciatica recover within 6 weeks and 90% recover within 12 weeks. 4,8 Despite being a mostly self-limiting condition, sciatica results in tremendous loss to our society in terms of decreased productivity, disability, and treatment costs. These costs are incurred both during the initial episode and over the long term.

The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model

“…6,57,80,143,156,162,173,176,[214][215][216][217][218][219][220][221][222][223][224][225][226][227][228][229][230] (Two studies were reported in a single publication; 223 studies 696 and 99999.) Seven studies included more than two arms.…”

“…Most of the non-opioid studies were RCTs (17/21, 81%), but none was good quality. Ten studies 6,143,161,214,218,220,223,224,227,228 were of moderate quality, most of which compared non-opioids with inactive control. Two of these studies 214,227 used adequate methods for random sequence generation and allocation concealment (comparators included inactive control, opioids and mixed treatment).…”

The efficacy and safety of corticosteroids in the treatment of acute and chronic pain

“…3 In 2008, Holve and Barkan found similar results with oral prednisone. 4 They compared a 9-day tapering dose of prednisone (60 mg, 40 mg and 20 mg) to a placebo group. They followed-up patients weekly in the first month, and then monthly for 5 months, and compared leg and back pain scores, use of analgesics, and quality of life and functionality questionnaires and showed that early use of oral prednisone had no significant improvement in sciatica patients.…”

“…They followed-up patients weekly in the first month, and then monthly for 5 months, and compared leg and back pain scores, use of analgesics, and quality of life and functionality questionnaires and showed that early use of oral prednisone had no significant improvement in sciatica patients. 4 In recent years, due to the lack of efficacy of oral corticosteroids in alleviating low back pain, attention and research has turned to an examination of the use of epidural steroid injections. This transition is supported by data showing improvement in symptoms, better treatment satisfaction scores and cost-effectiveness when steroid injections are used alone, or in addition with other modalities for managing low back pain.…”

The Medical Home, Health Services, and Clinical Family Medicine Research

“…Here we highlight studies that provide new/ clarifying results, [1][2][3][4][5] mixed results, [6][7][8] and unexpected results. 6,7 Several reports provide information and data on major tenets of family medicine: Clark et al 6 studied continuity between prenatal care and infant care; Mainous et al 5 described the long-term personal history importance to future risk of disease; and Merenstein and Merenstein 9 provide patient feedback on the importance of the doctor-patient relationship.…”