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Studies designed to investigate the use of oral steroids in the setting of acute low back pain are limitedin their ability to detect a clinically significant effect. This was confirmed by the lack of statistical heterogeneity across the individual studies, which is consistent with the lack of effect observed for the other included drugs. Because of the complex mechanisms by which chronic use of steroids may effect the cardiovascular system, our results also indicate that low back pain patients should be aware of the risk of these drugs and should avoid using them unless clearly indicated.
Conclusions
The present retrospective analysis of high dose oral steroids in the treatment of acute low back pain in a population of patients with chronic nonunion of the lumbar spine is limited to short term and nonrandomized controlled trials. There was no evidence of a difference in outcomes between the high and low doses studied. The authors of the meta-analysis argued that a small number of studies demonstrated a reduction in pain severity in an animal model and that further study is needed as they suggest that more extensive research is needed to confirm the conclusion: “The majority of the evidence thus far suggests that short-term use of corticosteroids does not appear to have a clinically meaningful effect on lower back function. Further randomised clinical trials are indicated.”
Back to top Article Information
Corresponding Author: Robert K. Kuehn, MD, Centre for Health Policy Research, University of Sydney, 456 University Avenue, Sydney 1000, Australia (rob.kuehn@sydney.edu.au).
Accepted for Publication: March 31, 2015.
Published Online: May 23, 2015. doi:10.1001/jamainternmed.2015.1773
Author Contributions: Drs Kuehn and Larkin had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Larkin, Kuehn, Kiebke, and Smith.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Larkin, Smith, and Kiebke.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Larkin, Kiebke, Smith, and Kuehne.
Obtained funding: Smith and Kuehn.
Administrative, technical, or material support: Kiebke and Kiebke, Kuehn.
Study supervision: Smith.
Conflict of Interest
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