Using systemic corticosteroids to treat low back pain

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.