Intravenous (IV) administration of methylprednisolone may be associated with short-term pain relief in patients with acute diskogenic sciatica, according to a study published in Pain Medicine.
In this multicenter double-blind controlled trial, individuals with confirmed acute diskogenic sciatica and leg pain (with an intensity >40 mm on a 0 to 100 mm visual analog scale), but without neurologic deficits, were randomly assigned to receive IV methylprednisolone 60 mg at 8:00 am and a 0.9% saline solution at 6:00 pm (n=17), IV ketoprofen 100 mg at 8:00 am and 6:00 PM (n=19), or placebo (0.9% IV saline at 8:00 am and 6:00 pm; n=17). The study’s primary outcome was change in the intensity of leg pain assessed at baseline and daily for 5 days after treatment. Secondary outcomes included lumbar pain at day 5, Straight Leg Raise Test and lumbar flexion index at day 5, oral morphine consumption at day 5, need for lumbar spine injections or surgery during the study.
The intensity of leg pain was comparable in the three treatment groups over the 5-day study period (P =.42). A greater percentage of patients receiving methylprednisolone vs ketoprofen or placebo had clinically relevant responses for leg pain (59%; 95% CI, 36-82% vs 16%; 95% CI, 0-32% and 18%; 95% CI, 0-36%, respectively; P <.01). Major responses (ie, a decrease in pain intensity ≥30 mm on a 0 to 100 mm scale) were more prevalent in participants treated with methylprednisolone vs ketoprofen or placebo (41%; 95% CI, 17-63% vs 5%; 95% CI, 0-15% and 0%; 95% CI, 0-5%, respectively; P <.01). The occurrence of total and serious adverse events was comparable in both groups.
Study limitations include its small sample size and the short duration of treatment and follow-up.
“[M]ethylprednisolone might be more efficient in managing pain in the first three days of hospital care in acute diskogenic sciatica…[t]his could be important to decreasing hospitalization stay durations,” the researchers noted.
Gastaldi R1, Durand M2, Roustit M, et al. Short-term efficiency and tolerance of ketoprofen and methylprednisolone in acute sciatica: A randomized trial [published online December 21, 2018]. Pain Med. doi:10.1093/pm/pny252