Oral steroids have limited efficacy in treating acute sciatica caused by herniated lumbar

by Bruce Sylvester: A short course of oral steroids brought only slight improvement in function and no significant improvement in pain among patients with acute sciatica caused by a herniated lumbar disk (acute radiculopathy), researchers reported on May 19, 2015 in  JAMA/Journal of the American Medical Association.

“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 investigator Harley Goldberg, DO, a spine care specialist at Kaiser Permanente Medical Center in San Jose, California. “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.”

Researchers from the Kaiser Permanente Northern California Spine Centers and the Kaiser Permanente Division of Research enrolled 269 adults in a randomized, double-blind, placebo-controlled clinical trial from 2008 to 2013.

Subjects had been diagnosed with radicular pain persisting three months or less, a functional impairment with a score of at least 30 on the Oswestry Disability Index and a herniated disk confirmed by magnetic resonance imaging.

The researchers randomized the subjects to a tapering 15-day course of oral prednisone or a placebo.

The prednisone-treated group achieved a modest likelihood of at least a 30-point (or 50 percent) improvement in function from week 3 to week 52 week. But the investigators found no statistically significant difference between patient cohorts for  changes in pain, at either week 3 or week 52.

“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,” said author Andrew Avins, MD, MPH, a senior scientist at the Division of Research. “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.”

The researchers also reported that oral steroids did not reduce the likelihood of surgery during the year after initiating steroid treatment. They also reported no significant improvements in other measures of quality of life.

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The study was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health.