Richard L Holve1, Howard Barkan. 1. Department of Family Medicine, Kaiser Permanente Medical Center, Santa Rosa, CA 95403, USA. Rich.Holve@kp.org
Abstract
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.
RCT Entities:
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.
Authors: Harley Goldberg; William Firtch; Mark Tyburski; Alice Pressman; Lynn Ackerson; Luisa Hamilton; Wayne Smith; Ryan Carver; Annu Maratukulam; Lawrence A Won; Eugene Carragee; Andrew L Avins Journal: JAMA Date: 2015-05-19 Impact factor: 56.272
Authors: Roger Chou; Rafael Zambelli Pinto; Rongwei Fu; Robert A Lowe; Nicholas Henschke; James H McAuley; Tracy Dana Journal: Cochrane Database Syst Rev Date: 2022-10-21
Authors: Rafael Zambelli Pinto; Chris G Maher; Manuela L Ferreira; Paulo H Ferreira; Mark Hancock; Vinicius C Oliveira; Andrew J McLachlan; Bart Koes Journal: BMJ Date: 2012-02-13