Will oral corticosteroids (steroids) exacerbate lumbar strain/sprain without radiculopathy (radicular symptoms)?

From the Guidelines

Oral corticosteroids are not recommended for treating lumbar strain/sprain without radiculopathy due to their lack of efficacy and potential side effects. The American College of Physicians and the American Pain Society guideline [ 1 ] states that systemic corticosteroids are not recommended for treatment of low back pain with or without sciatica, as they have not been shown to be more effective than placebo.

Key Points to Consider

• The use of oral corticosteroids for lumbar strain/sprain without radiculopathy is not supported by evidence [ 1 ].
• First-line treatment should include over-the-counter pain relievers like acetaminophen or NSAIDs, combined with gentle activity and avoiding bed rest [ 1 ].
• Muscle relaxants like cyclobenzaprine may help with muscle spasms for short periods [ 1 ].
• Physical therapy focusing on core strengthening and proper body mechanics is beneficial for recovery and prevention [ 1 ].
• The risks of steroids, including blood sugar elevation, mood changes, sleep disturbance, and immune suppression, outweigh any minimal benefit for simple lumbar strain [ 1 ].

Treatment Recommendations

• For acute low back pain, consider spinal manipulation or intensive interdisciplinary rehabilitation [ 1 ].
• For chronic or subacute low back pain, consider exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation [ 1 ].
• Clinicians should provide patients with evidence-based information on low back pain and advise patients to remain active [ 1 ].

From the Research

Oral Corticosteroids and Lumbar Strain/Sprain

• The use of oral corticosteroids for lumbar strain/sprain without radiculopathy is not well-established in the provided studies 2, 3, 4, 5, 6.
• However, a study on systemic corticosteroids for radicular and non-radicular low back pain found that the effects of systemic corticosteroids in people with non-radicular low back pain are unclear 4.
• The same study suggested that systemic corticosteroids may be associated with slightly worse short-term pain but slightly better function in people with non-radicular low back pain 4.
• Another study on oral steroids for acute radiculopathy due to a herniated lumbar disk found that a short course of oral steroids resulted in modestly improved function but no improvement in pain 5.
• There is no direct evidence to suggest that oral corticosteroids will exacerbate lumbar strain/sprain without radiculopathy, but the current evidence is limited and inconclusive 2, 3, 4, 5, 6.

Key Findings

• Systemic corticosteroids may have a slight effect on improving short-term pain and function in people with radicular low back pain 4.
• The effects of systemic corticosteroids on non-radicular low back pain are unclear 4.
• Oral steroids may improve function but not pain in patients with acute radiculopathy due to a herniated lumbar disk 5.
• The safety profile of epidural steroid injections may be improved with the development of safer, sterile formulations 6.

Considerations

• The use of oral corticosteroids for lumbar strain/sprain without radiculopathy should be approached with caution due to the limited and inconclusive evidence 2, 3, 4, 5, 6.
• Patients with lumbar strain/sprain without radiculopathy should be evaluated on a case-by-case basis, and treatment decisions should be made based on individual patient needs and medical history 2, 3, 4, 5, 6.