Steroids No Better for Sciatica Pain Than Placebo
Friday, June 05, 2015 08:38 AM

Doctors often prescribe steroid pills to ease the discomfort of sciatica -- back and leg pain usually caused by a herniated disk in the lower back.  But a new study finds steroids are no more effective than a placebo pill for the pain and provide only modest improvement in function.

Sciatica affects about one in 10 people in their lifetime, the researchers said. For this study, 269 people with sciatica were randomly assigned to take an oral steroid or a placebo for 15 days. The participants were followed for up to a year.

"When we compared the prednisone to placebo, there was a modest improvement in function," said study researcher. People reported they could go about their daily activities somewhat better than before.  However, "when we compared the pain [between the two groups], there was actually no difference," he said.

The finding "doesn't slam the door" on steroids as a treatment. Rather, it provides information for patients and their doctors to discuss and decide together the best treatment option.

Usual treatments for herniated disk-related sciatica range from self-care, steroid pills and anti-inflammatory medicines, physical therapy, or epidural steroid injections. When all else fails, surgery is an option.

This new study found that after a year, the likelihood of spine surgery was no less for those who took prednisone than for those who took a placebo, the researchers reported in the May 19 issue of the Journal of the American Medical Association.

The study results suggest that sometimes the best course is to let the body heal itself, said Dr. Nick Shamie, chief of orthopedic spine surgery at UCLA Medical Center, Santa Monica, who wasn't involved in the study.

Patients reported on functioning ability and pain levels for up to a year. The steroid-treated group was more likely to report a small improvement in functioning, defined as 50 percent, at three weeks and at one year. But pain was similar for both groups at those time points.

Side effects, such as insomnia, increased appetite and nervousness, were twice as common at three weeks in the steroid group. Nearly half reported at least one side effect, compared to about one-quarter of the placebo group. After one year, however, both groups had reported a similar number of side effects, the researchers said.

For anyone suffering from sciatica, Shamie said a specialist's evaluation and guidance is crucial. "Have them guide you," he said.  He cautioned against rushing to surgery, pointing to a 2006 study, also published in JAMA, that found sciatica patients were no better two years after surgery in terms of functioning and pain than those who did not have surgery.