Oral Steroids for Acute Radiculopathy Due to a Herniated Lumbar Disk: A Randomized Clinical Trial

Goldberg H, Firtch W, Tyburski M, et al. Oral steroids for acute radiculopathy due to a herniated lumbar disk: a randomized clinical trial. JAMA. 2015;313(19):1915-1923. doi:10.1001/jama.2015.4468

This is a clinical trial that was published in the Journal of the American Medical Association in 2015. In this trial the researchers wanted to determine the efficacy of oral prednisone on improving pain and function in patients with acute sciatica. The study was set in Northern California and 269 adults from 18-70 years old were recruited from 3 different primary care facilities. Selection was based on reported radiating leg pain that extended below the knee in a nerve root distribution within the last three months, a MRI which confirmed disc herniation, and a reported score of 30 points or higher on the Oswestry Disability Index. Patients were excluded from the study if they were experiencing pain for longer than 3 months, received oral steroid or epidural treatment within three months, or if they had previous lumbar surgery. Participants who were randomized to the active treatment group were placed on a prednisone taper of 60 mg for 5 days, the 40 mg for 5 days, and 20 mg for the last 5 days. While those in the placebo group received visually identical capsules. Neither group was permitted to take any NSAIDs. Three weeks after researchers re-measured the patient’s ODI score, reassessed pain using a numerical pain scale, and conducted a subjective interview to discuss improvements in pain. In all there was a marked improvement in functional status with minimal improvement in self reported pain.