What is the treatment for lumbar radiculopathy using a Medrol (methylprednisolone) dose pack?

Medrol Dose Pack for Lumbar Radiculopathy

Oral corticosteroids, including Medrol dose packs, are not recommended for lumbar radiculopathy as they provide no meaningful benefit over placebo and cause significant adverse effects including insomnia, nervousness, and increased appetite. 1

Evidence Against Systemic Corticosteroids

Efficacy Data

• Six trials consistently found no differences between systemic corticosteroids and placebo for pain relief in radicular low back pain of varying duration 1
• The largest high-quality trial (n=269) showed only a small effect on function (7.4-point difference in Oswestry Disability Index at 52 weeks), while two other trials found no functional benefits 1
• Systemic corticosteroids do not reduce the likelihood of requiring spine surgery 1
• For spinal stenosis specifically, a 3-week course of prednisone showed no differences from placebo in pain intensity or disability through 12 weeks of follow-up 1

Adverse Effects Profile

• Oral prednisone significantly increases risk of any adverse event (49% vs 24%) compared to placebo 1
• Specific harms include:
  • Insomnia (26% vs 10%) 1
  • Nervousness (18% vs 8%) 1
  • Increased appetite (22% vs 10%) 1

Recommended First-Line Treatment Instead

NSAIDs as Primary Therapy

• NSAIDs (such as naproxen) are recommended as first-line treatment for radiculopathy due to moderate efficacy and better safety profile 2
• NSAIDs target the inflammatory component of radicular pain 2
• Use the lowest effective dose to minimize gastrointestinal and cardiovascular risks 2

Gabapentin for Neuropathic Component

• Gabapentin shows small to moderate short-term benefits for radicular pain, particularly effective for the neuropathic component 2
• Doses typically titrated to 1200-3600 mg/day 2
• Use time-limited courses only, as gabapentin is not FDA-approved for low back pain with or without radiculopathy 2

Treatment Algorithm

1. Start with NSAIDs to address inflammatory component 2
2. Add gabapentin if neuropathic pain persists 2
3. Consider epidural steroid injections (not oral steroids) for persistent symptoms in surgical candidates 1
4. Advise patients to remain active and provide self-care education 1

Common Pitfalls to Avoid

• Do not prescribe oral corticosteroids (Medrol dose packs) for routine lumbar radiculopathy - the evidence shows no benefit with significant harms 1
• Avoid long-term use of any glucocorticoids for this indication 1
• Short courses of oral prednisolone may only be considered as bridging therapy in very specific circumstances, but this is not standard for radiculopathy 1
• Most patients with lumbar disc herniation and radiculopathy improve within the first 4 weeks with noninvasive management 1