Steroids Helpful or Not Helpful for Acute Sciatica Pain?

As noted in a new article from the May 19, 2015 issue of JAMA, oral steroid tapers are commonly used to treat acute sciatica due to a herniated disc.  The study performed a randomized clinical trial evaluating the use of a short course of an oral steroid taper for acute sciatica pain with a confirmed disc herniation on MRI reported modestly improved function and no improvement in pain in prednisone treated group compared to placebo at the end of one year.  

Oral steroid tapers such as the prednisone taper used in the study are commonly used medications in patients with an acute episode of sciatica (also known as a pinched nerve) to help reduce the inflammatory component of the a pinched nerve in the short term.  Such medications are not meant to be a long term cure all treatment for acute sciatica.  Rather, they should be an a potential tool in a treating physician’s treatment regimen to be used on a case by case basis.

Furthermore, the utility of analyzing the benefit of the medication to 52 weeks is unclear.  A case of sciatica that lasts for a year no longer fits the definition of acute sciatica and can carry a different prognosis from a clinical standpoint, even with surgical intervention.  Use of a short medication taper would not be expected to change the outcome in these chronic cases.