Oral Steroids for Acute Sciatica Due to Herniated Lumbar Disk

Oral Steroids for Acute Sciatica Due to Herniated Lumbar Disk

[Background Music] >> The JAMA Network [ Silence ] >> Hello, I'm Dr

Harley Goldberg, the Director of the Spine Care Program at Kaiser Permanente, Northern California We, of course, have a lot of patients with spine problems including herniated discs and acute radiculopathy And over the years we have moved, as many have, from the surgical treatment to the interventional treatment And it has been my observation clinically that people would get better with oral Prednisone as well as, perhaps, epidural steroid injections So because of that we underwent the randomized double blind clinical trial of oral Prednisone versus placebo for acute radiculopathy associated with a herniated lumbar disc

We randomized nearly 300 patients It was 269 patients that were adult patients enrolled in the Kaiser Permanente Program, who presented with clinical acute radiculopathy and who were found also to be confirmed with a positive MRI that matched clinically their clinical presentation They had a physical exam and then we used outcome instruments that included the Oswestry Disability Index and the Visual Analog Scale as well as subsets of the SF36 and other global questionnaires as well We studied whether or not oral Prednisone, in a two to one randomization with placebo, would improve pain and increase function in this patient population The results were no different between the randomized patients to placebo and those with Prednisone in terms of pain over the first three weeks and in fact at any point in the time course out of 52 weeks

We did find a statistically significant benefit in functional improvement but it was of minimal clinical improvement, that is to say it was less than seven points on a 100 point Oswestry scale While our dataset contains a lot more data for us to evaluate and determine perhaps other aspects of noninvasive treatment of their medications or other methods of care that may or may not be appropriate for this population, what was surprising to us was that the oral Prednisone did not in fact decrease the pain as we expected Our next steps will be to evaluate how these patients rolled over to an epidural steroid injection to a surgical outcome and/or the use of other concomitant pain medications throughout the course of this study, to let us infer what would be the next studies needed to find the optimal noninvasive treatments for this population What this trial does not answer is the nonspecific effects of placebo This trial does not have a normal treatment arm so we do not know actually what is the nonspecific effect of the placebo treatment? And that is one more question that is yet to be answered, as in any other placebo controlled trial

[ Music ]

Source: Youtube

Share this post