Oral Steroids and Back Pain

Oral steroids are commonly prescribed with little evidence and multiple potential for adverse effects. Who should take oral steriods, what are the risks and side effects?

Written by Gerard Malanga, MD

Oral steroids, or corticosteroids taken by mouth, are prescription anti-inflammatory medications that have been commonly prescribed for various orthopaedic conditions, including low back and neck pain. While these drugs can reduce pain and inflammation, they also have potential serious side effects that you should discuss with your doctor.

Corticosteroids can be administered in numerous ways, though injection and oral forms are the two most commonly used for spine pain. This article describes the basics of oral steroids, which come in tablets, capsules, or syrups.

How Oral Steroids Work
Oral steroids are designed to work in the same way as the hormones produced by your adrenal glands in response to stress and injury. When the corticosteroids you take raise your body’s natural adrenal hormones above their normal levels, this reduces inflammation. Corticosteroids also suppress your immune system, which helps people who suffer from autoimmune conditions (such as rheumatoid arthritis) but can also decrease your ability to fight infection.

Oral Steroids: General Dosing Information
Below are examples of oral steroids (generic names are listed first, and a brand name example is in parentheses):

Oral steroids are generally prescribed for a limited time—typically 1 or 2 weeks. In most cases, you will take your strongest dose on the first day of therapy and taper down until you do not have any medication left.

Oral steroids are prescribed in shorter doses because of their strength and potential side effects. You can learn more about that below.

Who Should Take Oral Steroids?
With a shorter course of therapy, these medications may help ease painful inflammation associated with severe acute back and neck pain (pain that arises and resolves quickly, though it may last up to 3-6 months). Oral steroids may also help with painful flare-ups common with chronic inflammatory diseases, such as rheumatoid arthritis. Common conditions treated with oral steroids include low back pain and herniated discs.

Oral Steroids Strengths and Weaknesses
Among the biggest benefits of oral steroids is that they offer relief from pain and inflammation without the invasiveness of their injected counterparts. Unlike spinal injections, oral steroids do not require MRI or radiation exposure, and may pose less of a risk for some patients. Spinal injections, however, deliver a more concentrated dose of corticosteroids with a lower degree of systemic (whole body) side effects.

Oral steroids do have some drawbacks, though. Compared to steroid injections, it takes longer for oral forms to take effect. Oral steroids also impact your entire body—not a single area like an injected form. Because of this, oral steroids carry more significant side effects than other delivery methods.

Possible side effects may include:

It is a long-held belief that short-term use of oral steroids provides protection against more serious side effects. However, a recent study published in April 2017 in the BMJ found that adults using oral steroids had a two-fold increased risk of fractures, a three-fold increased risk for venous thromboembolism, and a five-fold increased risk of sepsis within 30 days of starting the medication. The study authors recommend using the lowest dose of oral steroid possible to reduce the potential for these complications.1 In addition, there are no well-design studies that have supported the effectiveness of oral steroid medications for neck and low back pain.

If oral steroids are required as a long-term treatment—such as in treatment of certain inflammatory disorders (eg, lupus, ankylosing spondylitis)—you should be aware of the following side effects that may occur with prolonged use:

Safely Using Oral Steroids for Spine Pain
Oral steroids are prescription-only medications. During your visit with your doctor, ask about the side effects and complications associated with these drugs. Also, make sure you understand exactly how to properly use your oral steroid, as it may be on a tapered schedule in contrast to a simple one-pill-per-day regimen.

Safely using your drug means using it exactly as your doctor prescribes. If you have questions about how to use your oral steroid, call your doctor or speak to your pharmacist when you pick up your prescription.

Oral steroids can be an adjunct to reduce pain and inflammation from back or neck pain (particularly from a pinched nerve) when other treatments have failed, but it is essential to use them as your doctor orders to prevent potentially harmful side effects. If you complete your course of medication and find that, your pain is still interfering with your quality of life, talk to your doctor about other treatments (such as physical therapy, spinal injections, etc.) that you may explore.

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