From the Guidelines
Oral corticosteroids should not be tried for lumbar strain if Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and muscle relaxants are not effective, as they have not been shown to be more effective than placebo. The use of systemic corticosteroids for low back pain with or without sciatica is not recommended due to lack of evidence supporting their effectiveness 1. Instead, consideration should be given to non-pharmacologic therapies with proven benefits, such as spinal manipulation for acute low back pain or intensive interdisciplinary rehabilitation for chronic or subacute low back pain.
Some key points to consider when managing lumbar strain include:
- The limited evidence supporting the use of oral corticosteroids for acute low back pain, with most studies showing minimal to no benefit 1
- The potential side effects associated with steroid use, including mood changes, elevated blood sugar, increased infection risk, and fluid retention
- The importance of maintaining mobility and avoiding bed rest, as this can help promote natural resolution of inflammation and improve outcomes
- The need for further evaluation if pain persists beyond 4-6 weeks to rule out other underlying causes of back pain
In terms of alternative treatment approaches, options such as physical therapy, gentle stretching exercises, application of heat or cold, and gradual return to normal activities as tolerated may be beneficial for patients with lumbar strain who do not respond to NSAIDs and muscle relaxants. The focus should be on promoting natural recovery and maintaining mobility, rather than relying on oral corticosteroids with limited evidence of effectiveness.
From the Research
Treatment of Lumbar Strain
- The provided studies do not directly address the use of oral corticosteroids for lumbar strain when NSAIDs and muscle relaxants are not effective 2, 3, 4, 5, 6.
- However, the studies suggest that NSAIDs and muscle relaxants are commonly used to treat low back pain, including lumbar strain 3, 4, 5, 6.
- In cases where NSAIDs and muscle relaxants are not effective, other treatment options may be considered, such as physical therapy, heat therapy, and spinal manipulative therapy 3, 4.
- One study mentions the use of corticosteroid injections for sacroiliac sprain syndrome, but this is not directly related to lumbar strain 2.
- There is limited evidence on the use of oral corticosteroids for lumbar strain, and more research is needed to determine their effectiveness in this context.
Current Treatment Guidelines
- The current treatment guidelines for low back pain, including lumbar strain, recommend the use of NSAIDs and muscle relaxants as first-line treatments 3, 4, 5.
- If these treatments are not effective, other options may be considered, such as physical therapy, heat therapy, and spinal manipulative therapy 3, 4.
- The use of oral corticosteroids is not typically recommended as a first-line treatment for lumbar strain, but may be considered in certain cases where other treatments have failed 2.