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May 27, 2015
Oral Steroids Not Very Effective When Herniated Lumbar
Disks Cause Sciatica
San Jose, CA—Despite some guideline recommendations to prescribe a short course of oral steroids to improve pain and function in patients with acute sciatica caused by a herniated lumbar disk, the treatment is only modestly effective at best, according to a recent study.
The report, published recently in the Journal of the American Medical Association, notes the dearth of large-scale clinical trials on the use of oral steroids in this situation and points out that more than 10% of people will be affected by the condition, also called “acute radiculopathy,” at some point in their lives.
“These findings suggest that a short course of oral steroids (prednisone) is unlikely to provide much benefit for patients with sciatica due to a herniated disk in the lower back,” said lead author Harley Goldberg, DO, a spine care specialist at Kaiser Permanente’s San Jose Medical Center. “Despite its widespread use, we found that oral steroid treatment for acute sciatica is only modestly effective for improving function and is ineffective for reducing pain.”
For the study, researchers conducted a double-blind, placebo-controlled clinical trial from 2008 to 2013 involving 269 adults. All had radicular pain persisting 3 months or less, functional impairment with a score of at least 30 on the Oswestry Disability Index score (which ranges from 0-100, with higher numbers indicating greater dysfunction), and a herniated disk confirmed by magnetic resonance imaging.
Study participants were randomly assigned to receive either a tapering 15-day course of prednisone, with 5 days each of 60 mg, 40 mg, and 20 mg for a total cumulative dose of 600 mg or matching placebo. Results indicate that the prednisone-treated group showed a small but greater likelihood of achieving at least a 30-point or 50% improvement in function at 3 weeks and at 52 weeks. The difference between groups in reported pain was not statistically significant, however, at either the 3-week or 52-week time points.
“Whether the small improvement in function—without a subsequent improvement in pain—merits use of oral steroids for patients with sciatica is a difficult decision and, ultimately, becomes a personal one that must be weighed by individual patients and their care providers,” noted senior author Andrew Avins, MD, MPH. “The value of this type of research is in providing the information necessary for physicians and their patients to have a meaningful discussion of the benefits and risks.”
In addition to oral steroids, currently used treatment options for acute sciatica associated with a herniated disk include education on self-care, usually followed by epidural steroid injection (ESI), or even microdiskectomy if pain persists.
The article notes that oral steroids are a popular prescription because they can be delivered quickly by primary care providers, carry less risk, and are much less expensive than ESI. In addition to providing little relief, the anti-inflammatories also did not reduce the likelihood of undergoing surgery in the year following steroid treatment.
“More work is needed to identify which patients will have significant benefit from non-invasive therapies for acute radiculopathy associated with a herniated lumbar disk,” Goldberg noted.
 
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