Corticosteroids are widely prescribed worldwide. It is estimated that, at any point of time, about 1% of the general population is receiving oral corticosteroids.
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Limited impact of corticosteroid therapy on sciatica due to a herniated disk
Oral steroids are commonly used to treat acute sciatica due to a herniated disk but have not been evaluated in an appropriately powered clinical trial.
The aim of this study was to determine if oral prednisone was more effective than placebo in improving function and pain among patients with acute sciatica.
This was study was conducted from 2008 to 2013 in a large integrated health care delivery system in Northern California. Adults (n=269) with radicular pain for 3 months or less and a herniated disk confirmed by magnetic resonance imaging were eligible. Those included in the study were randomly assigned to receive a tapering 15-day course of oral prednisone (5 days each of 60 mg, 40 mg, and 20 mg; total cumulative dose = 600 mg; n = 181) or matching placebo (n = 88).
Overall, the study found that, compared with placebo, oral corticosteroids resulted in modestly improved function and no improvement in pain and there were no differences in surgery rates at 52-week follow-up. However, having 1 or more adverse events at 3-week follow-up was more common in the corticosteroid group than in the placebo group (49.2% vs 23.9%; P < .001). In conclusion, among patients with acute radiculopathy due to a herniated lumbar disk, a short course of oral steroids, compared with placebo, resulted in modestly improved function and no improvement in pain. The full abstract of this study can be accessed here