Panel findings and recommendations:
- Oral steroids are not recommended for the treatment of low back problems
. (Strength of Evidence = C
- A potential for severe side effects is associated with the extended use of oral steroids or the short-term use of steroids in high doses.
(Strength of Evidence = D
Oral steroids (corticosteroids) are used by some clinicians in the treatment of patients with low back problems. The therapeutic objective is to reduce inflammation in an attempt to promote healing and reduce pain.
Of six articles screened for this topic, the only one meeting criteria for review was Haimovic and Beresford.119
Two other articles also contained information used by the panel. 120
Evidence on Efficacy.
Haimovic and Beresford,119
in a double-blind RCT, evaluated patients with low back pain who had findings of a single nerve root irritation (symptom duration of patients not specified). Patients were randomly assigned to receive a 1-week course of either an oral dexamethasone or a placebo. On followup at the end of treatment and at 1 year, no significant differences were found between the two groups in terms of pain relief.
Potential Harms and Costs.
The incidence of side effects associated with steroids correlates with the potency of the drug, dosage, and duration of administration. Well-recognized complications from the prolonged use of oral steroids include suppression of pituitary adrenal function, fluid and electrolyte disturbance, hyperglycemia, demineralization of bone, and immunosuppression (with increased susceptibility to infection). While many of these effects can be reduced or eliminated with alternate-day therapy, even short-term daily use of high-dose steroids can contribute to posterior subcapsular cataract formation, myopathy, central nervous system disturbance, and avascular necrosis of bone, especially of the femoral head. 120
The expense of treatment varies greatly, depending on the medication used and the length of treatment.
Summary of Findings.
The limited available research evidence indicates that oral steroids do not appear to be an effective treatment for patients with low back problems. Serious potential complications are associated with long-term use, but potential complications appear minimal with short-term use.
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