From the Guidelines
Steroids are not recommended for the treatment of low back pain due to limited evidence of effectiveness and potential harms. The use of systemic corticosteroids for low back pain has been evaluated in several trials, but the results have been inconsistent and generally show no significant benefit in pain or function 1. For acute nonradicular low back pain, two trials found no differences between systemic corticosteroids and placebo in pain or function 1. Similarly, for radicular low back pain, six trials consistently found no differences between systemic corticosteroids and placebo in pain 1.
Some key points to consider when evaluating the use of steroids for low back pain include:
- The lack of evidence supporting the use of systemic corticosteroids for chronic nonradicular low back pain 1
- The potential harms associated with steroid use, including increased risk of adverse events, insomnia, nervousness, and increased appetite 1
- The importance of considering alternative treatments, such as non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, and exercise, which have more established evidence of effectiveness 1
In terms of specific treatment options, a short course of oral steroids such as prednisone (typically 20-40mg daily for 5-7 days, tapering down) might be considered for severe pain, but only after other treatments have failed and under close supervision. Epidural steroid injections may be considered for specific conditions like radicular pain from disc herniation, but these should be administered by specialists after other treatments have failed 1. Overall, the use of steroids for low back pain should be approached with caution and only considered in specific circumstances, given the limited evidence of effectiveness and potential harms.
From the Research
Steroids for Low Back Pain
- The use of systemic corticosteroids for low back pain has been studied, with moderate-certainty evidence indicating that they probably slightly decrease pain versus placebo at short-term follow-up 2.
- For radicular low back pain, systemic corticosteroids may slightly increase the likelihood of experiencing improvement in pain at short-term follow-up, and probably increase the likelihood of improvement in function at short-term follow-up 2.
- However, the effects of systemic corticosteroids in people with non-radicular low back pain are unclear, and they are probably ineffective for spinal stenosis 2.
- A single dose or short course of systemic corticosteroids for low back pain does not appear to cause serious harms, but evidence is limited 2.
- Oral steroids have been shown to be effective in improving function, but not pain, in patients with acute radiculopathy due to a herniated lumbar disk 3.
- Epidural injections with or without steroids for radiculopathy have been shown to be effective, 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.
Types of Steroids and Administration
- Systemic corticosteroids can be administered through oral, intravenous, or intramuscular routes 2.
- Epidural injections can be used to administer steroids directly to the affected area 4.
- Oral steroids, such as prednisone, have been studied for their effectiveness in treating acute radiculopathy due to a herniated lumbar disk 3.
Comparison to Other Treatments
- Spinal manipulation has been shown to make no difference to function compared to placebo for people with acute/subacute low back pain 5.
- Acupuncture has been shown to improve function slightly for people with chronic low back pain, compared to sham acupuncture or no treatment/usual care 5.
- Exercise therapies and multidisciplinary therapies have been shown to reduce pain intensity and improve function slightly for people with chronic low back pain, compared to no treatment/usual care 5.