Oral Steroids for Acute Sciatica: Improvement in Function Is Modest at Best

Thomas L. Schwenk, MD reviewing Goldberg H et al. JAMA 2015 May 19.

And treatment offered no relief from pain.

Oral steroids are used commonly in patients with acute lumbar radiculopathy or sciatica, but strong evidence of benefit is lacking. In this study, researchers at a large California health system randomized 269 patients (mean age, 46) with acute sciatica, magnetic resonance imaging–confirmed disc herniation, and substantial functional impairment to a tapering course of oral prednisone (60 mg daily for 5 days, 40 mg daily for 5 days, and 20 mg daily for 5 days) or placebo. Patients with pain for >3 months, recent epidural or oral steroid use, or previous lumbar surgery were excluded. The 1-year rate of spine surgery was the same in both groups (about 10%).

In adjusted analyses, improvement in function was significantly greater in the prednisone group than in the placebo group (mean difference between groups on a 100-point scale, 6.4 points at 3 weeks and 7.4 points at 52 weeks). A significantly higher proportion of prednisone versus control patients had >50% improvement in function at 3 weeks (33% vs. 20%) and 52 weeks (87% vs. 68%); the corresponding numbers needed to treat to benefit one patient at those time points were 7.6 and 5.5, respectively. No differences were found between groups on any pain measure. Minor adverse effects (e.g., nervousness, insomnia, increased appetite) were roughly twice as common in the prednisone group at 3 weeks.

Citation(s):

Goldberg H et al. Oral steroids for acute radiculopathy due to a herniated lumbar disc: A randomized clinical trial. JAMA 2015 May 19; 313:1915