Pain From Sciatica Not Helped By Oral Steroids

Harley Goldberg, DO Physical Medicine and Rehabilitation Kaiser PermanenteMedicalResearch.com Interview with:
Harley Goldberg, DO
Physical Medicine and Rehabilitation
Kaiser Permanente

Medical Research: What is the background for this study? What are the main findings?

Dr. Goldberg: This is the first large-scale randomized, double-blind, placebo-controlled clinical trial of oral steroids for acute radiculopathy, commonly called sciatica, associated with a herniated lumbar disk.

Lumbar radiculopathy (or pain down the leg in a lumbar nerve root distribution) is a common source of pain and disability for many adults. It is thought that inflammation from a disk herniation is responsible for many of the symptoms, so giving a powerful anti-inflammatory, such as steroid medication, might help relieve sciatica symptoms quickly. Prior research has shown that lumbar diskectomy does not affect the one year outcome for most patients, and epidural steroid injections do not have strong support by clinical trials. If the use of epidural steroids injections is based on application of steroid anti-inflammatory to the affected nerve root(s), perhaps an oral steroid can have affect. Although oral steroids are used by many physicians and have been included in some clinical guidelines, no large-scale clinical trials of oral steroids for sciatica have been conducted before.

Our study found that among patients with acute radiculopathy associated with a herniated lumbar disk, a short course of oral steroids resulted in only modest improvement in function and no significant improvement in pain.

Medical Research: What should clinicians and patients take away from your report?

Dr. Goldberg: For many years, physicians have given their patients these short courses of steroids under the assumption that they are highly effective for many or most patients. We now know that may not be true and that most patients given oral steroids will do just as well with a placebo.

Each patient with acute radiculopathy (sciatica) will need to weigh the benefits and risks of taking a short course of oral steroids with their physician. The value of this research lies in being able to provide patients and physicians with hard evidence so that they can have a meaningful and informed discussion about balancing the relative benefits and risks associated with using a short course of oral steroids for acute radiculopathy in the context of other treatment options.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Goldberg: We will further evaluate our data set, to assess indications for any further research questions. More work is needed to identify which patients will have significant benefit from non-invasive therapies for acute radiculopathy associated with a herniated lumbar disk.

Looking more broadly, this study showcases the power and potential of evidence-based research. I would encourage other researchers to test other common medical practices that are based on anecdotal evidence to see if they hold up.

Citation:

Goldberg H, Firtch W, Tyburski M, et al. Oral Steroids for Acute Radiculopathy Due to a Herniated Lumbar Disk: A Randomized Clinical Trial. JAMA. 2015;313(19):1915-1923. doi:10.1001/jama.2015.4468.

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MedicalResearch.com Interview with:Harley Goldberg, DO Physical Medicine and Rehabilitation, & Kaiser Permanente (2015). Pain From Sciatica Not Helped By Oral SteroidsĀ