This Rx Wasn't Much Help for Back Pain

Oral steroid prednisone may not relieve herniated disk pain but may boost function

(RxWiki News) One steroid thought to help some patients with back pain may not be all that helpful.

A new study found that an oral steroid called prednisone (brand names Deltasone, Orasone and Sterapred) didn’t help people with back pain from a herniated disk.

While this may seem disappointing, this finding may help doctors eliminate treatments that are not useful and find more successful therapies, said the authors of this study.

For this study, researchers led by Harley Goldberg, DO, of the Kaiser Permanente Northern California Spine Center in San Jose, looked at prednisone as a possible pain reliever for chronic back pain.

“Over the years we have moved — as many have — from the surgical treatment to the interventional treatment,” Dr. Goldberg said in a press release. “It has been my observation clinically that people would get better with oral prednisone."

Although Dr. Goldberg and team found patients to have significant functional improvement while on the drug, prednisone was found to have minimal clinical improvement overall.

William H. Baumgartl, MD, director of stem cell therapies at Nevada Spine Center and leader of the Second Opinion/Consult program for Advanced Pain Diagnosis and Treatment, told dailyRx News that the results of this study were surprising.

"In my clinical experience, oral steroids are usually much more effective than reported in this study, and I am not sure why a bigger difference is NOT seen between the treated/placebo groups," Dr. Baumgartl said. "Perhaps the steroid dosing was not optimal."

Dr. Baumgartl added, "I think further research on oral steroids is warranted, as I think the technique is helpful in the primary practice and ER setting, who often first see these patients, and are not equipped to do epidural steroids injections quickly (the current standard). The interesting study to also see would be to compare epidural steroids to oral in the acute setting."

Back pain can limit function and affect many aspects of patients' daily lives.

Chronic pain can be caused by a herniated or slipped disk. Formally known as a nucleus pulposus, a disk is the spongy cartilage between the bones or vertebrae in the spine.

When the disk protrudes into the spinal column — which can happen due to injury or normal wear and tear — it puts pressure on the spinal nerves, causing pain and inflammation. Although surgical treatment was once the norm, medical care today is more likely to be conservative, as research has shown that many people can recover without surgery.

For those who do not recover, however, treatment can be frustrating and may not be effective in relieving pain or restoring function. Functional problems might include leg or muscle weakness or loss of flexibility.

Although prednisone is often used in patients with back pain, this was the first controlled, randomized trial to measure the effects of oral prednisone against placebo (fake pills).

Steroids like prednisone can have an anti-inflammatory effect. Back pain from a herniated disk may result from inflammation of the nerves.

Dr. Goldberg said he had previously observed in his clinical practice that patients on oral steroids seemed to improve. Dr. Goldberg and colleagues selected 269 adults who had back pain, a minimum level of disability and a herniated disk that had been confirmed with MRI studies.

These researchers split the patients into two groups. They used a clinical tool called the Oswestry scale to measure pain and disability.

One group of 181 patients received 15 days of oral prednisone in gradually decreasing doses — for a total dose of 600 milligrams per patient. The second group received placebos designed to look exactly like the prednisone.

Neither patients nor doctors knew which pills the patients received.

Patients on prednisone showed a slight boost in function as measured by the Oswestry scale, Dr. Goldberg and team found. Steroids, however, did not relieve pain as expected.

Dr. Goldberg and team said they plan to continue their study to see how the patients do with other types of treatments, such as epidural steroid injections or surgery.

"Previous studies on steroids have consistently shown that it does not change operative rates, but simply gets patients to their natural endpoint more quickly, and allows patients who will ultimately require surgery to be identified more quickly," Dr. Baumgartl said. "Previous studies also show that most patients are able to recover without operative treatment, but the average recovery time with natural recovery was about two years, while epidural steroids (for instance) reduced this time to under three months to reach the same endpoint, with a very quick initial reduction in pain and improvement in function."

This study was published May 19 in JAMA.

The National Institutes of Health funded this research. Study author Dr. Eugene Carragee received travel support from the US Army, grants from the Orthopaedic Research and Education Foundation and AOSpine, and options from Simpirica and Intrinsic Orthopedics, which make products used in the treatment of herniated disks.

Review Date: 
May 18, 2015