From the Guidelines
Systemic corticosteroids, such as prednisone, are not recommended for the treatment of acute low back pain with sciatica, as they have not been shown to be more effective than placebo 1. Instead, the treatment plan should focus on nonpharmacologic therapies with proven benefits, such as spinal manipulation for acute low back pain, and intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation for chronic or subacute low back pain 1. The patient should be advised to remain active and informed about effective self-care options, including recommendations to stay active, which is more effective than resting in bed for patients with acute or subacute low back pain 1. If medication is necessary, other options such as gabapentin, tricyclic antidepressants, or herbal therapies like devil's claw, willow bark, and capsicum may be considered, but the evidence for their effectiveness is limited and they should be used with caution 1. It's essential to monitor the patient's symptoms and adjust the treatment plan accordingly, considering the potential risks and benefits of each therapy. In cases where severe symptoms are present, a short course of prednisone may be considered, but this should be done under the guidance of a healthcare provider and with careful monitoring of potential side effects 1.
From the Research
Prednisone Taper for Acute Low Back Pain with Sciatica
- The use of prednisone to treat acute sciatica is a common practice among physicians, but there is limited clinical evidence to support its effectiveness 2.
- A double-blind, controlled clinical trial found that patients who received a 9-day tapering course of prednisone had more rapid rates of improvement in pain, mental well-being, and disability scores compared to the control group 2.
- However, another study found that a short course of oral corticosteroids did not benefit patients with musculoskeletal low back pain in the emergency department 3.
- The efficacy of epidural injections for lumbar radiculopathy or sciatica has been supported by multiple systematic reviews and meta-analyses, with significant improvement in pain relief and functional status 4.
- A comparative systematic review and meta-analysis found that epidural injections with or without steroids showed significant effectiveness in treating radiculopathy, with Level I or strong evidence for local anesthetic with steroids and Level II to I or moderate to strong evidence with local anesthetic alone 4.
- Oral opioid analgesics and spinal steroid injections have been compared in the treatment of low back pain syndromes, with spinal steroid injections showing benefits in the short-term, but oral opioid therapy may be helpful, although its effectiveness is limited by adverse effects 5.
- The current evidence suggests that prednisone may have a subtle but statistically significant effect on improving pain, mental well-being, and disability scores in patients with acute sciatica, but its impact on other outcomes is limited 2, 3.