Acute Lower Back Problems in Adults - Steroids

Oral Steroids

Panel findings and recommendations:

• Oral steroids are not recommended for the treatment of acute low back problems. (Strength of Evidence = C.)
  
• A potential for severe side effects is associated with the extended use of oral steroids or the short–term use of steroids in high doses. (Strength of Evidence = D.)

Oral steroids (corticosteroids) are used by some clinicians in the treatment of patients with acute low back problems. The therapeutic objective is to reduce inflammation in an attempt to promote healing and reduce pain.

Literature Reviewed.
Of six articles screened for this topic, the only one meeting criteria for review was Haimovic and Beresford. [119] <http://text.nlm.nih.gov> Two other articles also contained information used by the panel. [120] <http://text.nlm.nih.gov>, [121] <http://text.nlm.nih.gov>

Evidence on Efficacy.

Haimovic and Beresford, [119] <http://text.nlm.nih.gov> in a double–blind RCT, evaluated patients with low back pain who had findings of a single nerve root irritation (symptom duration of patients not specified). Patients were randomly assigned to receive a 1–week course of either an oral dexamethasone or a placebo. On followup at the end of treatment and at 1 year, no significant differences were found between the two groups in terms of pain relief.

Potential Harms and Costs.

The incidence of side effects associated with steroids correlates with the potency of the drug, dosage, and duration of administration. Well–recognized complications from the prolonged use of oral steroids include suppression of pituitary–adrenal function, fluid and electrolyte disturbance, hyperglycemia, demineralization of bone, and immunosuppression (with increased susceptibility to infection). While many of these effects can be reduced or eliminated with alternate–day therapy, even short–term daily use of high–dose steroids can contribute to posterior subcapsular cataract formation, myopathy, central nervous system disturbance, and avascular necrosis of bone, especially of the femoral head. [120] <http://text.nlm.nih.gov>, [121] <http://text.nlm.nih.gov>
The expense of treatment varies greatly, depending on the medication used and the length of treatment.

Summary of Findings.

The limited available research evidence indicates that oral steroids do not appear to be an effective treatment for patients with acute low back problems. Serious potential complications are associated with long–term use, but potential complications appear minimal with short–term use.

Colchicine

Panel findings and recommendations:

• Based on conflicting evidence of effectiveness as well as the potential for serious side effects, colchicine is not recommended for treating patients with acute low back problems. (Strength of Evidence = B.)

Colchicine has been used primarily to treat acute attacks of gouty arthritis and can be administered intravenously or orally. The therapeutic objective of using the drug in patients with acute low back problems is to reduce inflammation and thereby reduce pain.

Literature Reviewed.

Of 13 articles screened, 3 RCTs met criteria for review. [122] <http://text.nlm.nih.gov>– [124] <http://text.nlm.nih.gov> Schnebel and Simmons [123] <http://text.nlm.nih.gov> evaluated only patients with acute low back problems of less than 3 months' duration. Meek, Giudice, McFadden, et al. [122] <http://text.nlm.nih.gov> evaluated patients with symptoms of more than 2 months. Simmons, Harris, Koulisis, et al. [124] <http://text.nlm.nih.gov> evaluated those with symptoms lasting up to 6 months.

Evidence on Efficacy.

Schnebel and Simmons [123] <http://text.nlm.nih.gov> found no statistically significant difference between oral colchicine and a placebo, although the oral colchicine group did have significantly more diarrhea and vomiting than the placebo group. Simmons, Harris, Koulisis, et al., [124] <http://text.nlm.nih.gov>who compared groups receiving either intravenous colchicine or intravenous saline, found significantly improved pain ratings for the colchicine group, but pain relief was short–lived (lasting from 1 hour to 2 days). Also, two patients in the colchicine group developed complications (diarrhea and a local inflammatory response). Meek, Giudice, McFadden, et al., [122] <http://text.nlm.nih.gov> who evaluated for 1 month a group receiving one dose of intravenous colchicine followed by oral colchicine, compared with a group receiving placebo, found significantly greater pain relief in the colchicine group.

Potential Harms and Costs.

Potential complications from the use of colchicine are gastrointestinal irritation, skin problems, severe chemical cellulitis from intravenous infiltration, and bone marrow suppression with agranulocytosis. [124] <http://text.nlm.nih.gov> The expense of treatment with colchicine varies greatly, depending on whether oral or intravenous administration is used and on length of treatment.

Summary of Findings.

Research evidence is limited and conflicting on whether colchicine, given either orally or intravenously, is an effective treatment for patients with acute low back problems. Serious potential side effects have been reported with use of this medication.


Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults.
Clinical Practice Guideline No. 14. AHCPR Publication No. 95–0642.
Rockville, MD: Agency for Health Care Policy and Research, Public Health
Service, U.S. Department of Health and Human Services. December 1994.