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Systemic corticosteroids may be marginally efficacious to alleviate short-term pain and functional impairment in patients having radicular low back pain not due to spinal stenosis, and may improve long-term functions.
For the management of radicular low back pain in adults, systemic corticosteroids use is associated with a slight reduction in pain in the short term and betterment in restoration of normal activities. In the long‐term, it may slightly improve the individual's ability to carry out normal activities, as deciphered from a study published in the "Cochrane Database of Systematic Reviews". This study aimed to explore the efficacy of systemic corticosteroids versus placebo or no corticosteroid for symptomatic spinal stenosis and low back pain (radicular and non-radicular).
Standard and extensive Cochrane search methods were used. Quasi-randomized and randomized studies comparing systematic corticosteroids vs placebo or no corticosteroid were incorporated. Standard Cochrane procedures were employed. Pain, function, the requirement for surgery, severe adverse effect, and hyperglycemia presence were the main outcomes. Quality of life, good outcomes, mild adverse events, and withdrawal due to noxious effects were considered minor outcomes. GRADE was used to determine each outcome's level of evidence confidence.
The inclusion criteria were fulfilled by 13 trials (1047 volunteers). Overall, 9 trials encompassed subjects having radicular low back pain, 2 trials encompassing spinal stenosis, and 2 trials encompassing low back pain. The use of systemic corticosteroids was concealed from volunteers in every trial. One experiment had a high risk of selection bias, five had an unknown risk, and seven studies had a low risk of bias. Attrition bias was a serious concern in 2 studies. Systemic corticosteroid therapy had varying doses and durations.
For radicular low back pain, using systemic corticosteroids might raise the chance of experiencing betterment in pain at the short-term follow-up (risk ratio [RR] 1.21, 95% confidence interval (CI) 0.88 to 1.66; absolute effect 5% better (95% CI 5% worse to 15% better) according to moderate-certainty evidence. It may possibly reduce pain vs placebo at the short-term follow-up (mean difference (MD) 0.56 points better, 95% confidence interval (CI) 1.08 to 0.04 on a 0 to 10 scale).
Systemic corticosteroids probably elevate the chance of betterment in function at the short-term follow-up (RR 1.52, 95% CI 1.22 to 1.91; absolute effect 19% better, 95% CI 8% better to 30% better). But, it might not improve function at the short-term follow-up (standardised mean difference (SMD) 0.14 better; range 0.49 better to 0.21 worse). Based on findings from a single trial, systemic corticosteroids were linked to both a larger probability of betterment in functions (RR 1.29, 95% CI 1.06 to 1.56) and a higher betterment in function compared to placebo at the long-term follow-up.
No difference was witnessed in the probability of surgery (RR 1.00, 95% CI 0.68 to 1.47). Systemic corticosteroids (given as a single dosage or as a brief treatment course) were not linked to an elevated risk of any noxious events, severe noxious events, hyperglycemia, or withdrawal due to noxious events. There isn't much evidence assessing systemic corticosteroids to placebo for non-radicular pain. Systemic corticosteroids may trigger somewhat worse short-term discomfort but slightly better function. Limited research suggested that systemic corticosteroids are likely no more beneficial than a placebo for treating short-term pain or function in spinal stenosis-affected people.
In individuals with radicular low back pain not caused by spinal stenosis, systemic corticosteroids seem to be marginally beneficial to combat short-term pain and function, and may marginally improve long-term function. Probably, systemic corticosteroids are not efficacious to relieve spinal stenosis, and their effects in persons with non-radicular low back pain are unknown. There is insufficient information to conclusively say whether a single dosage or brief term of systemic corticosteroids for low back pain elicits major adverse effects.
Cochrane Database of Systematic Reviews
Systemic corticosteroids for radicular and non-radicular low back pain
Roger Chou et al.
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