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Low back pain: no corticosteroids

There is no evidence that systemic corticosteroids have any efficacy on low back pain, beyond a placebo effect. Furthermore, they expose patients to numerous adverse effects.

Low back pain is common in adults. It is sometimes accompanied by pain spreading into the lower limbs (radiculalgia). In most cases, it improves spontaneously, within a few days or weeks. When low back pain persists for more than three months, it is termed chronic. In most cases, there is no identifiable cause.

Several trials have compared systemic corticosteroid therapy with a placebo. Their results converge and show that systemic corticosteroids have no proven efficacy over and above a placebo effect in relieving pain or reducing functional discomfort in patients with acute or chronic low back pain, with or without radiculalgia.

On the other hand, these drugs expose nearly one in two patients to adverse effects, even from short courses of treatment, the most common being insomnia, nervousness and increased appetite. Some adverse effects can be serious: thrombosis, infections, fractures.

In cases of acute or chronic low back pain, with or without radiculalgia, it is best to avoid the use of corticosteroids: there is no evidence of their effectiveness beyond a placebo effect, and they expose patients to sometimes serious adverse effects.

©Prescrire 1 September 2018

"Low back pain. No demonstrated efficacy of systemic corticosteroids" Prescrire Int 2018; 27 (196): 219. (Pdf, subscribers only).

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