Steroids for ED treatment of Lower Back Pain
The Article: Prednisone for Emergency Department Low Back Pain: A Randomized Controlled Trial. Eskin et al. (2014) J Emerg Med. 47(1): 65-70.
The Idea: To determine if a short course of oral corticosteroids benefits patients with musculoskeletal lower back pain.
The Study: A prospective randomized controlled study at one suburban hospital ED. Seventy-nine patients were randomly assigned to receive either a 5 day course of 50mg prednisone daily or placebo. Inclusion criteria included patients aged 18-55 with a diagnosis of musculoskeletal lower back pain (LBP) from a bending/twisting injury within 48 hours of moderate or greater intensity (>5/10 on a visual analog scale, VAS) or with acute exacerbations of chronic back pain. Exclusion criteria included blunt trauma to the lower back, lower extremity neuro deficits, neoplastic disease, fever, pregnancy, diabetes, uncontrolled HTN, significant PUD, cataracts, UTI, current use of steroids or other immunosuppressants, prednisone allergy, lactose intolerance, visits from an occupational medicine program or refusal to participate. The patients received one dose of 50mg prednisone or placebo in the ED and were given 4 pills of the same to go home with. Additional analgesia was prescribed at the discretion of the treating physician. Pain was assessed using VAS score on arrival and discharge from the ED. Patients were followed up at 5-7 days after discharge and pain was reassessed using a verbal rating scale (VRS 0-3: none = 0, mild = 1, moderate = 2, severe = 3). The primary outcome was pain at follow up via VRS pain scale. Secondary outcomes included a dichotomized pain scale (none or mild), need for further medical intervention, resuming normal household chores, need for further evaluation from a general practitioner, and days missed of work.
The Findings: There was no significant difference in VRS score between the two groups at 5-7 days. More patients in the intervention group sought additional medical treatment and had more days missed from work. No side effects were reported in either group.
The Takeaway: In patients presenting to the emergency department with musculoskeletal lower back pain, a short course of oral corticosteroids did not improve pain scores at 5-7 days compared to placebo.