Oral prednisone confers modest improvements in function — but no improvement in pain — among patients with sciatica due to a herniated disk, a JAMA study finds.
Some 270 adults with radicular pain of no more than 3 months’ duration, disability scores of 30 or higher (on a 100-point scale), and a confirmed herniated disk were randomized to receive 15 days’ treatment with either oral prednisone or placebo. Prednisone was started at 60 mg/day and tapered to 20 mg/day.
Compared with placebo, the prednisone group showed small improvements in disability scores at 3 weeks (an average 6-point greater improvement) and 1 year (7-point greater improvement). Pain scores, however, did not differ significantly between the groups at either time point.
NEJM Journal Watch General Medicine‘s Thomas Schwenk says that while “the mean improvement in function with prednisone is statistically significant … its clinical importance is marginal.” He adds: “The side effects of using oral prednisone in patients with acute sciatica are minimal but so are the benefits.”