From the Guidelines
Steroids can contribute to muscle weakness, particularly with prolonged use at higher doses, due to their effects on protein breakdown and synthesis in muscle tissue, as well as potential bone loss. When considering the impact of steroids on back muscles, it's essential to weigh the benefits against the potential harms, including muscle atrophy and weakness. According to a systematic review published in the Annals of Internal Medicine 1, systemic corticosteroids do not seem to be effective for low back pain, and their use may be associated with adverse effects such as insomnia, nervousness, and increased appetite. The mechanisms by which corticosteroids contribute to muscle weakness include increasing protein breakdown and decreasing protein synthesis in muscle tissue, leading to muscle wasting, as discussed in a narrative review published in Arthritis Care & Research 1. Additionally, corticosteroids can cause bone loss (osteoporosis), which may indirectly affect the spine and surrounding musculature. Key points to consider:
- Patients on long-term steroid therapy (typically more than 3 months) at doses exceeding 5-7.5mg of prednisone daily may experience muscle weakening effects.
- To minimize muscle weakening, patients should engage in regular weight-bearing exercise, maintain adequate protein intake, and follow the lowest effective dose for the shortest duration necessary.
- Anabolic steroids, designed to build muscle mass, carry significant health risks and are not recommended for medical use except in specific conditions like muscle wasting diseases. It's crucial to prioritize the patient's overall health and well-being when considering steroid use, taking into account the potential benefits and harms, as well as individual factors such as dose and duration of therapy.
From the Research
Steroids and Back Muscles
- The use of corticosteroids has been associated with multiple potential adverse effects, including toxicity to articular cartilage and numerous systemic side effects such as increases in blood glucose levels, a reduction in immune function, and an increased risk of infections 2.
- Prolonged, high-dose corticosteroid use has been linked to complications including avascular necrosis, gastrointestinal bleeding, myocardial infarction, heart failure, cerebrovascular events, diabetes mellitus, psychiatric syndromes, ophthalmic complications, tuberculosis reactivation, and bacterial sepsis 3.
- For acute low back pain, very low certainty evidence showed that non-benzodiazepine antispasmodics were associated with a reduction in pain intensity compared with control, but not a reduction in disability 4.
- There is fair evidence that cyclobenzaprine, carisoprodol, orphenadrine, and tizanidine are effective compared to placebo in patients with musculoskeletal conditions, including acute back or neck pain 5.
- However, there is no direct evidence to suggest that steroids specifically weaken back muscles, but rather that they can have adverse effects on the musculoskeletal system as a whole 2, 3.
Muscle Relaxants and Back Pain
- Muscle relaxants, such as non-benzodiazepine antispasmodics, may provide small but not clinically important reductions in pain intensity at or before two weeks for acute low back pain, and may increase the risk of an adverse event 4.
- Cyclobenzaprine has been evaluated in the most clinical trials and has consistently been found to be effective for musculoskeletal conditions, including acute back or neck pain 5.
- The use of muscle relaxants for low back pain is associated with considerable uncertainty about their clinical efficacy and safety, and large, high-quality, placebo-controlled trials are needed to resolve this uncertainty 4.
Safety and Efficacy of Steroids and Muscle Relaxants
- The safety and efficacy of corticosteroids and muscle relaxants for the treatment of low back pain and musculoskeletal conditions are not well established, and more research is needed to fully understand their effects 2, 3, 4, 5.
- Clinicians should be aware of the potential adverse effects of corticosteroids and muscle relaxants, and should carefully weigh the benefits and risks of these medications when treating patients with low back pain and musculoskeletal conditions 2, 3.