title: Prednisone for emergency department low back pain: a randomized controlled trial.
abstract: BACKGROUND
  Although oral corticosteroids are commonly given to emergency department (ED) patients with musculoskeletal low back pain (LBP), there is little evidence of benefit.
  
  
  OBJECTIVE
  To determine if a short course of oral corticosteroids benefits LBP ED patients.
  
  
  METHODS
  
  
  
  METHODS
  Randomized, double-blind, placebo-controlled trial.
  
  
  METHODS
  Suburban New Jersey ED with 80,000 annual visits.
  
  
  METHODS
  18-55-year-olds with moderately severe musculoskeletal LBP from a bending or twisting injury ≤ 2 days prior to presentation. Exclusion criteria were suspected nonmusculoskeletal etiology, direct trauma, motor deficits, and local occupational medicine program visits.
  
  
  METHODS
  At ED discharge, patients were randomized to either 50 mg prednisone daily for 5 days or identical-appearing placebo. Patients were contacted after 5 days to assess pain on a 0-3 scale (none, mild, moderate, severe) as well as functional status.
  
  
  RESULTS
  The prednisone and placebo groups had similar demographics and initial and discharge ED pain scales. Of the 79 patients enrolled, 12 (15%) were lost to follow-up, leaving 32 and 35 patients in the prednisone and placebo arms, respectively. At follow-up, the two arms had similar pain on the 0-3 scale (absolute difference 0.2, 95% confidence interval [CI] -0.2, 0.6) and no statistically significant differences in resuming normal activities, returning to work, or days lost from work. More patients in the prednisone than in the placebo group sought additional medical treatment (40% vs. 18%, respectively, difference 22%, 95% CI 0, 43%).
  
  
  CONCLUSIONS
  We detected no benefit from oral corticosteroids in our ED patients with musculoskeletal LBP.
authors.affiliation: Department of Emergency Medicine, Morristown Medical Center, Morristown, New Jersey.
authors.forename: Barnet
authors.initials: B
authors.lastname: Eskin
authors.affiliation: Department of Emergency Medicine, Morristown Medical Center, Morristown, New Jersey.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Shih
authors.affiliation: Department of Emergency Medicine, Morristown Medical Center, Morristown, New Jersey.
authors.forename: Frederick W
authors.initials: FW
authors.lastname: Fiesseler
authors.affiliation: Department of Emergency Medicine, Morristown Medical Center, Morristown, New Jersey.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Walsh
authors.affiliation: Department of Emergency Medicine, Morristown Medical Center, Morristown, New Jersey.
authors.forename: John R
authors.initials: JR
authors.lastname: Allegra
authors.affiliation: Department of Emergency Medicine, Morristown Medical Center, Morristown, New Jersey.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Silverman
authors.affiliation: Department of Emergency Medicine, Morristown Medical Center, Morristown, New Jersey.
authors.forename: Dennis G
authors.initials: DG
authors.lastname: Cochrane
authors.affiliation: Department of Emergency Medicine, Newton Medical Center, Newton, New Jersey.
authors.forename: David F E
authors.initials: DF
authors.lastname: Stuhlmiller
authors.affiliation: Department of Emergency Medicine, Morristown Medical Center, Morristown, New Jersey.
authors.forename: Oliver L
authors.initials: OL
authors.lastname: Hung
authors.affiliation: Department of Emergency Medicine, Morristown Medical Center, Morristown, New Jersey.
authors.forename: Alex
authors.initials: A
authors.lastname: Troncoso
authors.affiliation: Department of Emergency Medicine, Morristown Medical Center, Morristown, New Jersey.
authors.forename: Diane P
authors.initials: DP
authors.lastname: Calello
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000188:drug therapy*; D010147:Pain Measurement; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies
chemical_list: D000893:Anti-Inflammatory Agents; D011241:Prednisone
keywords: low back pain; musculoskeletal pain; steroids