Systemic corticosteroids for radicular and non-radicular low back pain

Area of Science:

• Rheumatology
• Pain Management
• Pharmacology

Background:

• Systemic corticosteroids possess anti-inflammatory and immunosuppressant properties.
• Their use for low back pain (radicular, non-radicular, spinal stenosis) is common but evidence on benefits and harms is uncertain.

Purpose of the Study:

• To evaluate the benefits and harms of systemic corticosteroids versus placebo for various types of low back pain in adults.

Main Methods:

• Included randomized and quasi-randomized trials comparing systemic corticosteroids to placebo or no corticosteroid.
• Searched Cochrane methods up to September 2021.
• Assessed pain, function, surgery need, serious adverse effects, and hyperglycemia using GRADE.

Main Results:

• For radicular low back pain, moderate evidence suggests slight short-term pain reduction and probable functional improvement.
• Evidence for non-radicular low back pain is limited, indicating potentially worse short-term pain but better function.
• For spinal stenosis, limited evidence suggests corticosteroids are likely ineffective for short-term pain or function.

Conclusions:

• Systemic corticosteroids show slight benefit for short-term pain and function in radicular low back pain, with potential long-term functional improvement.
• Effectiveness for non-radicular low back pain is unclear; they are likely ineffective for spinal stenosis.
• Short-term use appears safe, but evidence on harms is limited due to reporting issues.