Could Oral Prednisone Improve Sciatica Outcomes?

In patients with sciatica from a herniated disk, treatment with oral prednisone yielded some improvements to function, but no improvement in pain, according to a recent study.

In the past, oral steroids have been commonly prescribed for acute sciatica from herniated disk, but the efficacy of this method had not been analyzed in a clinical trial.
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Researchers conducted a randomized, double-blind, placebo-controlled clinical trial from 2008 to 2013 with 269 adults who had radicular pain for 30 months or less. The eligibility of participants was determined by a confirmed herniated disk from MRI and a score of 30 or higher on the Oswestry Disability Index (ODI).

For the study, 181 participants were assigned to a tapering 15-day course of oral prednisone in a 2:1 ratio: 5 days 60 mg, 5 days 50 mg, 5 days 20 mg. Eighty-eight patients were assigned a matching placebo.

The study showed that participants in the prednisone group had slight improvements in disability scores at 3 weeks—a 6.4-point improvement over the placebo group and at 1 year, the prednisone group had a 7.4-point greater improvement compared to those administered placebos. However, pain scores did not significantly differ between the groups at 3 weeks or at 1 year.

“Whether the observed improvement in function (without concomitant improvement in pain) merits use of oral steroids for patients with an acute radiculopathy is a difficult decision and, ultimately, becomes a personal one that must be weighed by individual patients and their physicians,” they concluded.

 The full study was published in the May issue of the Journal of the American Medical Association.

—Michelle Canales Butcher

Reference:

Goldberg H, Firtch W, Tyburski M, et al. Oral steroids for acute radiculopathy due to a herniated lumbar disk. JAMA. 2015;313(19):1915-1923.