Steroids No Better for Sciatica Pain Than Placebo

Sciatica affects about 1 in 10 people in their lifetime, researchers say. For this new study, 269 people with sciatica were randomly assigned to take an oral steroid (prednisone) or a placebo for 15 days. The participants were followed for up to a year.

“When we compared the prednisone to placebo, there was a modest improvement in function,” said study researcher Dr. Harley Goldberg, director of spine care services at Kaiser Permanente San Jose Medical Center in California. People reported they could go about their daily activities somewhat better than before.

However, “when we compared the pain [between the two groups], there was actually no difference,” he said.

Usual treatments for herniated disk-related sciatica range from self-care, steroid pills and anti-inflammatory medications, physical therapy, or epidural steroid injections, Goldberg said. When all else fails, surgery is an option, he explained.

This new study found that after a year, the likelihood of spine surgery was no less for those who took prednisone than for those who took a placebo, the researchers reported in the May 19 issue of the Journal of the American Medical Association.

The study, which ran from 2008 to 2013, included adults who had had the radiating leg and buttock pain for up to three months and said it affected their daily lives. All had a herniated disk, which triggers the pain, confirmed by an MRI.

Side effects, such as insomnia, increased appetite and nervousness, were twice as common at three weeks in the steroid group. Nearly half reported at least one side effect, compared to about one-quarter of the placebo group.

For anyone suffering from sciatica, Dr. Nick Shamie, chief of orthopedic spine surgery at UCLA Medical Center, Santa Monica, said a specialist’s evaluation and guidance is crucial. “Have them guide you,” he said.

He cautioned against rushing to surgery, pointing to a 2006 study, also published in JAMA, that found sciatica patients were no better two years after surgery in terms of functioning and pain than those who did not have surgery.



If patients are overweight, Goldberg advises losing weight. “There’s no direct evidence that weight loss helps, but we believe it does,” he said. He can’t comment on other options such as acupuncture, because they were beyond the scope of his study.

My Take:
It is unfortunate (and convenient) that the scope of the study did not include alternative forms of care for sciatica, most notably chiropractic care. I treat sciatica every day in my office. Honestly, it is not that difficult to treat.

Steroids can have horrendous side effects. Long term use leads to steroid disease with osteoporosis, adrenal failure and potential death. I have also witnessed steroid psychosis in my patient population from use of these powerful hormones.

There are numerous studies that demonstrate the effectiveness of chiropractic care in the treatment of sciatica. Acupuncture can also be quite effective and ice is the best anti-inflammatory, with no side effects.

The Bottom Line:
If you suffer from sciatica please seek alternative methods of care. Natural anti-inflammatory tools like ice, fish oil, ginger, turmeric and Boswellia are very effective without the negative side effects. Spinal manipulation is by far the most effective tool in treating sciatica.

Source: May 19, 2015 National Institutes of Health