How effective—and safe—are systemic steroids for acute low back pain?
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Short courses of systemic steroids are likely safe, but they are ineffective. A single dose of intramuscular (IM) or intravenous (IV) methylprednisolone doesn't improve long-term pain scores in patients with low back pain and sciatica and produces conflicting effects on function. Oral prednisone (9-day taper) doesn't improve pain or function in patients with back pain and sciatica. A single IM dose of methylprednisolone doesn't improve pain scores or function in patients with back pain without sciatica (strength of recommendation: B, randomized controlled trials [RCTs]). No trials of corticosteroids for back pain reported an increase in adverse outcomes, but studies were small, and only short-term (1 month) follow-up data are available.
Journal of Family Practice, 60(5) 2011: 297-298.