From the Guidelines
For radiculopathy, a short course of oral corticosteroids, such as prednisone starting at 60mg daily for 5 days, followed by a taper over the next 5-7 days, is recommended to reduce inflammation and potentially provide pain relief and improved function. This recommendation is based on the most recent and highest quality study available, which found that systemic corticosteroids were associated with small effects on function, but no differences in pain, for radicular low back pain of varying duration 1.
Key Considerations
- The largest good-quality trial found that oral prednisone increased the risk for any adverse event, insomnia, nervousness, and increased appetite 1.
- Patients should be monitored for potential adverse effects, including mood changes, insomnia, increased blood glucose, and fluid retention.
- Steroids should be used cautiously in patients with diabetes, hypertension, glaucoma, or peptic ulcer disease.
Treatment Details
- A methylprednisolone dose pack (Medrol) can be used as an alternative, which provides a pre-packaged 6-day tapered regimen starting at 24mg on day 1 and gradually decreasing to 4mg by day 6.
- It's essential to take the medication with food to minimize gastrointestinal side effects.
- This treatment is typically used as part of a comprehensive approach that may include physical therapy, activity modification, and other pain management strategies.
Important Notes
- Longer courses of steroids are generally not recommended due to increasing risk of side effects without additional benefit.
- The treatment should be individualized based on the patient's specific condition and medical history.
From the Research
Recommended Steroid Dosing for Radiculopathy
- The optimal steroid dosing for radiculopathy is not well established, but several studies provide guidance on the effectiveness of different dosing regimens.
- A study published in 2013 2 found that a short course of oral prednisolone (50 mg/day for 5 days, tapered over the next 5 days) was effective in reducing pain and improving function in patients with cervical radiculopathy.
- Another study published in 2015 3 found that a 15-day course of oral prednisone (60 mg/day for 5 days, 40 mg/day for 5 days, and 20 mg/day for 5 days) resulted in modestly improved function and no improvement in pain in patients with acute radiculopathy due to a herniated lumbar disk.
- Transforaminal epidural steroid injections (TFESIs) have also been shown to be effective in managing lumbar radiculopathy, with a study published in 2006 4 finding that a preganglionic approach was more effective than a conventional approach in treating lumbar radiculopathy.
- A study published in 2024 5 found that TFESIs were effective in about 80% of patients with radiculopathy, with a mean follow-up period of 116 weeks.
- A systematic review published in 2003 6 found strong evidence for the effectiveness of transforaminal epidural injections in managing lumbar nerve root pain, but limited or inconclusive evidence for the effectiveness of epidural injections in managing chronic spinal pain without radiculopathy.
Key Findings
- Oral steroids can be effective in reducing pain and improving function in patients with radiculopathy, but the optimal dosing regimen is not well established.
- TFESIs can be effective in managing lumbar radiculopathy, with a preganglionic approach potentially being more effective than a conventional approach.
- The effectiveness of epidural injections in managing chronic spinal pain without radiculopathy is limited or inconclusive.