Oral prednisone improves function, not pain in acute lumbar radiculopathy

1. In this randomized controlled study of acute lumbar radiculopathy, oral prednisone improved function at weeks 3 and 52 when compared to placebo.

2. In this randomized controlled study, there was no difference between oral prednisone and placebo in improvement of below the waist pain at weeks 3 or 52 or rates of spinal surgery within one year.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Acute lumbar radiculopathy, or sciatica, is pain radiating down the lower extremities due to nerve compression by a herniated spinal disk. Sciatica is common in the United States and can be managed conservatively or, when more severe, with spinal steroid injections or surgical procedures. This study randomized Kaiser Permanente of Northern California members between 18 and 70 years of age with sciatica to receive oral prednisone or placebo. At 3 weeks and 52 weeks, participants in the prednisone arm had a greater reduction in Oswestry Disability Index (ODI) scores when compared to individuals in the placebo arm. There was no difference in below the waist pain between the two study groups at 3 weeks or 52 weeks. Individuals in the prednisone group also had higher physical activity scores on the Short Form 36 (SF36) when compared to the placebo group at 3 weeks and higher mental component summary scores in the SF36 at 52 weeks.

Strengths of this study include the use of a randomized controlled methodology, high adherence to interventions and follow-up, and the utilization of several outcomes that were followed over a full 52 weeks. This study is limited by the fact that all participants were from Northern California and the use of stringent inclusion and exclusion criteria that may limit generalizability. Overall, this study found that oral prednisone for sciatica improves function but does not ameliorate pain. A larger study should be done to more completely understand the utility of oral prednisone in the management of sciatica.

Click to read the study, published today in JAMA

Relevant Reading: Sciatica

In-Depth [randomized controlled study]: This study randomized 269 individuals with acute lumbar radiculopathy to receive either a 15-day oral prednisone taper or placebo and followed improvements in function and pain for 52 weeks. Study participants randomized to the intervention arm took 60 mg of prednisone daily for 5 days, followed by 40 mg of prednisone daily for 5 days, followed by 20 mg of prednisone daily for 5 days. Participants randomized to prednisone had a greater reduction in ODI scores than did individuals randomized to the placebo arm at weeks 3 (p = 0.01) and 52 (p = 0.003). There was no difference between the two groups in pain below the waist at weeks 3 (p = 0.34) or 52 (p = 0.15). Participants in the prednisone arm had a greater improvement in the physical activity score of the SF36 at 3 weeks (mean 3.3 points; 95%CI 1.3-5.2; p = 0.001) and mental component score of the SF36 at 52 weeks (mean 3.6 points; 95%CI 0.6-6.7; p = 0.02). Over the course of the one-year follow up, there was no difference in the rates of spine surgery between the two groups (9.9% vs. 9.1%; RR 1.2; 95%CI 0.5-2.6; p = 0.68).

Image: PD

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