Efficacy and harms of orally, intramuscularly or intravenously administered glucocorticoids for sciatica: A systematic review and meta-analysis.
There is insufficient evidence to strongly support or dismiss the use of glucocorticoids via the oral, IM or IV routes in people with sciatica as the evidence ranged from very low to moderate quality. One small trial (n=78) reported small improvements in pain and moderate improvements in disability with intramuscular injection of methylprednisolone acetate 160 mg in the immediate term. However there is low quality evidence of no immediate term pain relief with oral corticosteroids. There was moderate quality evidence of a two-fold greater risk of non-serious AEs with oral prednisone compared with placebo. We were unable to report information on long term complications associated with corticosteroid use as few studies reported on outcomes in the long term.
Adverse events (AE)
The adverse events reported in the RCTs included glucocorticoid-specific adverse events e.g. hyperglycaemia, mood changes, dyspepsia were reported in six studies (see eTable 5 for description of AEs reported) (Porsman et al., 1979; Hedeboe et al., 1982; Hofferberth et al., 1982; Finckh et al., 2006; Friedman et al., 2008; Goldberg et al., 2015). The severity of AEs was described as mild by study authors. Five serious AEs were reported in one study (Goldberg et al., 2015), 3/157 in the prednisone group and 2/77 in the placbo group. The three SAEs reported in the prednisone group included appendectomy, suicide attempt and deep venous thrombosis."
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