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Oral steroids are commonly prescribed with little evidence and multiple potential for adverse effects. Who should take oral steroids, what are the risks and side effects?
Corticosteroids, or oral steroids, are prescription anti-inflammatory medications commonly prescribed for various orthopaedic conditions, including low back and neck pain. These drugs can reduce pain and inflammation, but they can also have serious side effects that you should discuss with your doctor.
The most commonly used forms of corticosteroids for spine pain are injections and oral forms. Oral steroids, which come in tablets, capsules, or syrups, are discussed in this article.
How Oral Steroids Work
In the same way that your adrenal glands produce hormones in response to stress and injury, oral steroids also work in the same way. Corticosteroids reduce inflammation when they increase your body's natural adrenal hormones above their normal levels. Additionally, corticosteroids suppress your immune system, which helps people suffering from autoimmune conditions (such as rheumatoid arthritis), but decreases your ability to fight infection.
Oral Steroids: General Dosing Information
Below are examples of oral steroids (generic names are listed first, and a brand name example is in parentheses):
* Methylprednisolone (Medrol)
* Prednisone (Deltasone)
* Dexamethasone (Decadron)
Oral steroids are generally prescribed for a limited time—typically 1 or 2 weeks. In most cases, you will take your strongest dose on the first day of therapy and taper down until you do not have any medication left.
* For example: You might take 7 oral steroid pills on day 1, 6 pills on day 2, and so on until you reach 1 pill a day. Then, at the end of the week (or second week), you take no more medication.
Oral steroids are prescribed in shorter doses because of their strength and potential side effects. You can learn more about that below.
Who Should Take Oral Steroids?
These medications may help ease the painful inflammation associated with severe acute back and neck pain (pain that occurs and resolves quickly, though it may last for up to 3-6 months). Inflammatory disorders such as arthritis and rheumatoid arthritis, such as chronically inflamed rheumatologic conditions, are often treated with oral steroids. Herniated discs and low back pain are two common conditions treated with oral steroids.
Oral Steroids Strengths and Weaknesses
It is one of the biggest advantages of oral steroids that they offer relief from pain and inflammation without the invasiveness of injections. For some patients, oral steroids may pose less of a risk than spinal injections, since they do not require radiation or an MRI. Although spinal injections do not have a high degree of systemic (whole body) side effects, they deliver a higher concentration of corticosteroids.
There are some drawbacks to oral steroids, however. The effects of oral steroids take longer to manifest than those of injections. Like injected steroids, oral steroids affect your entire body rather than a single area. Since oral steroids are more potent, they carry a greater risk of side effects.
Possible side effects may include:
* Weight gain
* Elevated blood pressure
* Increased eye pressure (glaucoma)
* Swollen legs
* Psychological changes, such as mood swings, memory loss, and behavioral changes
* Sleep difficulties
It is a long-held belief that short-term use of oral steroids provides protection against more serious side effects. However, a recent study published in April 2017 in the BMJ found that adults using oral steroids had a two-fold increased risk of fractures, a three-fold increased risk for venous thromboembolism, and a five-fold increased risk of sepsis within 30 days of starting the medication. The study authors recommend using the lowest dose of oral steroid possible to reduce the potential for these complications.1 In addition, there are no well-designed studies that have supported the effectiveness of oral steroid medications for neck and low back pain.
If oral steroids are required as a long-term treatment—such as in treatment of certain inflammatory disorders (eg, lupus, ankylosing spondylitis)—you should be aware of the following side effects that may occur with prolonged use:
* Slower wound healing and increased skin bruising
* Increased infection risk
* Clouding or blurred vision
* High blood sugar
* Osteoporosis and fractures
* Avascular necrosis of bone (death of bone due to lack of blood supply)
Safely Using Oral Steroids for Spine Pain
Oral steroids are prescription-only medications. During your visit with your doctor, ask about the side effects and complications associated with these drugs. Also, make sure you understand exactly how to properly use your oral steroid, as it may be on a tapered schedule in contrast to a simple one-pill-per-day regimen.
Safely using your drug means using it exactly as your doctor prescribes. If you have questions about how to use your oral steroid, call your doctor or speak to your pharmacist when you pick up your prescription.
Oral steroids can be an adjunct to reduce pain and inflammation from back or neck pain (particularly from a pinched nerve) when other treatments have failed, but it is essential to use them as your doctor orders to prevent potentially harmful side effects. If you complete your course of medication and find that your pain is still interfering with your quality of life, talk to your doctor about other treatments (such as physical therapy, spinal injections, etc.) that you may explore.
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