Oral steroids in initial treatment of acute sciatica.
OBJECTIVE
Many physicians use prednisone to treat acute sciatica with the hope of speeding recovery. There is little clinical evidence to support this practice. Our objective was to determine whether early administration of oral prednisone affects parameters related to recovery from acute sciatica.


METHODS
In this double-blind, controlled clinical trial, 27 patients were sequentially assigned to receive either a 9-day tapering course of prednisone (n = 13) or placebo (n = 14) within 1 week of developing sciatic symptoms. Patients and investigators were blinded to the drug administered. Follow-up assessment was done weekly for 1 month and then monthly for 5 months.


RESULTS
Prednisone and control groups showed no statistically significant differences in physical findings, use of nonsteroidal anti-inflammatory drugs or narcotic medications, or rates of patients returning to work at any time interval studied. Compared with controls, patients who received prednisone had more rapid rates of improvement from baseline in pain, mental well-being, and disability scores. These changes were subtle but statistically significant. Patients who received prednisone tended to receive fewer epidural injections for pain.


CONCLUSIONS
Early administration of oral steroid medication in patients with acute sciatica had no significant effect on most parameters studied. It did, however, lead to slightly more rapid rates of improvement in pain, mental well-being, and disability scores. The impact of oral steroids on other outcomes is suggested by this study, but its small sample size limited its statistical power.
Holve
Richard L
RL
Department of Family Medicine, Kaiser Permanente Medical Center, Santa Rosa, CA 95403, USA. Rich.Holve@kp.org
Barkan
Howard
H
D000208:Acute Disease; D000284:Administration, Oral; D000328:Adult; D004185:Disability Evaluation; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011241:Prednisone / Q000008:administration & dosage*; D012585:Sciatica / Q000188:drug therapy* / Q000503:physiopathology / Q000534:rehabilitation; D012720:Severity of Illness Index; D016896:Treatment Outcome
D005938:Glucocorticoids; D011241:Prednisone