A new study from researchers at the Kaiser Permanente-Northern California Spine Care Center in San Jose evaluated the likelihood of helping sciatica patients recover faster with a short course of oral steroids. Led by Harley Goldberg, D.O., the group s findings may disappoint the many physicians who rely upon the non-invasive use of prednisone and similar oral steroids to ameliorate the often-excruciating pain and disability attendant upon herniated lumbosacral discs.
The study appeared in the recent JAMA. Sciatica is a clinical diagnosis: it occurs when a lumbosacral nerve root is impinged upon by disc fragments or fluid from a herniated/ruptured disc. The patient describes pain of variable severity emanating from the low-back region and radiating down the route of the nerve, generally from the buttocks to the hamstring or inner thigh areas and sometimes right down to the ankle and foot. If severe, long-lasting or associated with clear evidence of nerve (motor or sensory) dysfunction, CT scanning or MRI studies are done.
In the current study, the group assessed 269 patients with MRI confirmation of disc herniation with sciatic pain and limited mobility. The northern California researchers divided the study subjects into two groups: one group, consisting of two-thirds (n=181) of the total, got prednisone over 15 days: 5 days of 60 mg, 5 days of 40 mg, and 5 days of 20 mg. The control group (n=88) received lookalike placebo pills only. All patients had standardized evaluations of both pain and disability.
The outcomes: pain and mobility ratings showed improvement for both groups. People who took prednisone reported, on average, a small gain in the ability to function, compared with those who took the placebo a difference of about six points on a 100-point scale at three weeks into their treatment and seven points after a year. However, essentially no difference was found in their reporting of pain at any point during the study. Also, about 49 percent of people who took prednisone (vs. 24 percent of the others) reported side effects, mainly insomnia, nervousness and increased appetite. Within the year, about 9 percent of both groups opted for back surgery.
ACSH s Dr. Gil Ross had this comment: While there was no miracle discerned from this study, the fact that those patients who received steroids had a persistent benefit in functional ability at one year after treatment albeit a small improvement seems to me to be of significance. The side effects of medium-dose steroids affected almost half the study group, but these were of minimal consequence. Although most studies have concluded that oral steroids have little effect on low-back pain, whether from lumbar nerve impingement (sciatica) or not, clinicians have continued to use these drugs: this is likely the result of balancing a patient's desire to believe that some treatment is ongoing with the knowledge that improvement is likely unrelated to the Rx. Doctors go along, given the knowledge that the pain will typically improve soon. The large majority of sciatica symptoms resolve within a few weeks with or without treatment. Doctors know that for most patients, a short course of oral steroids is not risky. It s not surprising that patients and their doctors continue to believe that steroids were effective, given how often the pain resolves during treatment.
