From the Guidelines
Prednisone is not recommended as a first-line treatment for lumbar strain due to its lack of effectiveness and potential for significant side effects. For acute low back pain or lumbar strain, the preferred initial treatments include over-the-counter pain relievers like acetaminophen (Tylenol) or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) at doses of 400-600mg every 6-8 hours or naproxen (Aleve) 220-440mg twice daily, combined with activity modification and gentle stretching 1.
Some key points to consider when treating lumbar strain include:
- The use of systemic corticosteroids, such as prednisone, is not recommended due to a lack of evidence showing their effectiveness in treating low back pain with or without sciatica 1.
- Nonpharmacologic therapies, such as spinal manipulation, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, yoga, cognitive-behavioral therapy, or progressive relaxation, may be considered for patients who do not improve with self-care options 1.
- Most lumbar strains resolve within 2-4 weeks with conservative management, including appropriate pain control, gentle movement, heat or ice therapy, and gradually returning to normal activities as tolerated.
It is essential to weigh the potential benefits and risks of any treatment, including prednisone, and consider the individual patient's needs and circumstances. However, based on the current evidence, prednisone is not a recommended treatment for lumbar strain, and other options should be considered first 1.
From the Research
Treatment Options for Lumbar Strain
- The use of prednisone for lumbar strain is not widely recommended, as evidence suggests it may not be effective in reducing pain or improving function 2.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are often recommended as a first-line treatment for acute low back pain, including lumbar strain, due to their moderate efficacy in reducing pain and disability 3, 4, 5.
- Other treatment options for lumbar strain may include:
- Physical medicine and rehabilitation, such as continued activity, lumbar spine orthotics, thermotherapy, cryotherapy, and spinal manipulative therapy 4.
- Muscle relaxants, which may be used for spasms and pain reduction, although their effects are unclear for chronic low back pain 4, 5.
- Acetaminophen, although its effectiveness for acute low back pain is unclear, and it may not provide additional benefit 3, 5.
Evidence for Prednisone Use
- A randomized controlled trial found no benefit from oral corticosteroids, including prednisone, in patients with musculoskeletal low back pain 2.
- Another study found that epidural corticosteroid injections may be beneficial for short-term symptom relief in patients with radicular pain, but the evidence is inconclusive for oral corticosteroids like prednisone 6.