Clinical Question

What are the benefits and harms of using systemic corticosteroids for the management of radicular and nonradicular low back pain or symptomatic spinal stenosis in adults?

Evidence-Based Answer

In patients with radicular low back pain, systemic corticosteroids increase the likelihood of improvement in function at short-term follow-up (absolute improvement = 19% better; 95% CI, 8% to 30% better). In adults with nonradicular low back pain, the use of systemic corticosteroids does not lead to a discernible effect on pain or function. Systemic corticosteroids are not beneficial in treating pain or function in those with spinal stenosis. A short course of systemic corticosteroids does not appear to cause harm.¹ (Strength of Recommendation: B, inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Low back pain can be categorized by etiology as radicular (lumbar disc or nerve root abnormalities), nonradicular mechanical (a combination of muscle, ligament, tendon, or bony abnormalities not resulting from spinal stenosis or disc or nerve root abnormalities), symptomatic due to spinal stenosis (narrowing of the spinal canal from bony and/or soft tissue structures), or back pain secondary to rheumatologic, inflammatory, metabolic, or malignant conditions. Management of low back pain may be specific to etiology and guided by duration of symptoms: acute pain (less than four weeks), subacute pain (four to 12 weeks), or chronic pain (more than 12 weeks). The authors sought to determine the benefits and harms of systemic corticosteroids two to 12 weeks after administration for low back pain that was radicular, nonradicular mechanical, or symptomatic due to spinal stenosis.