Paper Chase 1 – Steroids for Lumbar Radiculopathy

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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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Fred L. -

Sanjay’s and Mike’s conclusion that, “in selected patients, it is reasonable to give a short burst of steroids [for radiculopathy]” really does not follow from this study. Even the study authors didn’t make that leap. Their conclusion was, “Among patients with acute radiculopathy due to a herniated lumbar disk, a short course of oral steroids, compared with placebo, resulted in modestly improved function and no improvement in pain.”

Disability in most radiculopathy patients (assuming no lawyers are involved) has two causes: pain and the side effects of treatment. While this study showed a statistically significant difference in ODI disability scores, there is no evidence that this translated into any clinically significant difference. More importantly, there was no difference in pain scores. This almost guarantees that the statistically significant difference in ODI scores is of no clinical significance, particularly since the authors excluded patients with ongoing litigation or workers compensation claims. Not surprisingly, there were more side effects in the steroid than the placebo group. So we’re left with no clinical benefit but demonstrated harms. I think the conclusion should have been: 15 days of oral steroids for radiculopathy has no proven benefit but does have harms. Finally, Sanjay and Mike might want to try taking a 15 day course of steroids before glibly labeling it as a “short burst.”

Sean G., M.D. -

what he said!( Fred L). I certainly did not take from this study give the potentially toxic steroids to your pt with a transient condition that will not be significantly improved in the long term. I have no doubt something as simple as participation in a yoga program would blow away the use of steroids here. Our approach is far too "pill happy". There is no debate corticosteroids cause damage to bones tendons ligaments mucosa...so please, lets reserve them for condition where they truly benefit such as COPD at least until we find a real tx for such conditions ie one that is proactive and not reactive.

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