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Therapeutics/Prevention
Randomised controlled trial
Oral steroids for improved function but not pain in acute radiculopathy due to disc herniation
  1. Steven P Cohen
  1. Johns Hopkins Medical Institutions & Walter Reed National Military Medical Center, Baltimore, Maryland, USA
  1. Correspondence to : Dr Steven P Cohen, Johns Hopkins Medical Institutions, 550 North Broadway, Suite 301, Baltimore, MD 21205, USA; scohen40{at}jhmi.edu

http://dx.doi.org/10.1136/ebmed-2015-110240

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    Commentary on: Goldberg H, Firtch W, Tyburski M, et al. Oral steroids for acute radiculopathy due to a herniated lumbar disk: a randomised clinical trial. JAMA 2015;313:1915–23.OpenUrlCrossRefPubMed

    Context

    The toll low back pain (LBP) exerts on society is enormous. Approximately 40% of cases of chronic LBP are primarily neuropathic in nature,1 which may make them responsive to corticosteroids. A randomised trial performed in 208 patients with acute radiculopathy found that 30% of those who received piroxicam or placebo continued to experience symptoms at 3 months, with few people reporting resolution afterwards.2 These results are consistent with other studies suggesting that radicular pain that persists for longer than 3 months after injury is likely to become chronic. For systemic steroids, most but not all studies have failed to demonstrate significant benefit.3

    Methods

    The authors performed a randomised, double-blind, placebo-controlled …

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    Footnotes

    • Competing interests SPC served as a consultant for Semnur Pharmaceuticals, which is trying to develop an FDA-approved steroid for epidural injection.

    • Provenance and peer review Commissioned; internally peer reviewed.