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Using systemic corticosteroids to treat low back pain
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Using systemic corticosteroids to treat low back pain
Are systemic corticosteroids effective and safe for the treatment of radicular low back pain, non-radicular low back pain and spinal stenosis?
For radicular low back pain (not due to spinal stenosis), 5 trials provided moderate-certainty evidence that systemic corticosteroids are probably more effective than placebo at decreasing pain at short-term follow-up (measured as a continuous outcome). Systemic corticosteroids were also associated with a small improvement in function versus placebo at long-term follow-up, based on one large trial with low risk of bias.
Systemic corticosteroids probably do not reduce the likelihood of undergoing surgery to remove a slipped or bulging disc.
For non-radicular pain, systemic corticosteroids may slightly worsen pain and slightly improve function versus placebo at immediate or short-term follow-up (low to moderate-certainty evidence).
For spinal stenosis, there is probably no difference between systemic corticosteroids and placebo at short-term follow-up.
Regarding harms, there was low-certainty evidence that systemic corticosteroids are not associated with increased risk of any adverse event, serious adverse events or hyperglycaemia in participants with radiculopathy.
This review was restricted to randomised placebo-controlled trials of systemic corticosteroids. It did not evaluate the effects of systemic corticosteroids compared with other medications or non-pharmacological treatments. Further, the review did not evaluate the effects of non-systemic corticosteroids, such as administration as an epidural, intradiscal, facet joint or trigger point injection, or administration perioperatively.
Systemic corticosteroids administered through the oral, intravenous or intramuscular routes have been used to treat various types of low back pain, including radicular back pain (not due to spinal stenosis), non-radicular back pain and spinal stenosis. However, there is uncertainty about the benefits and harms of systemic corticosteroids for low back pain.
Chou R, et al. Systemic corticosteroids for radicular and non-radicular low back pain. Cochrane Database Syst Rev 2022;10:CD012450. This review contains 13 trials with a total of 1047 participants.