Corticosteroids: use them wisely

Marketed for more than fifty years, corticosteroids – drugs containing cortisone – are used in many pathologies, and in particular inflammatory pain.

And it is common for doctors to prescribe these drugs for low back pain.

They are generally given to patients who have stubborn pain against which paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, preferred as first-line, no longer have any effect.

A prescription which however is not based on solid scientific data.

Indeed, the results of clinical trials comparing treatment with oral corticosteroids (tablets, effervescent tablets, etc.) with a placebo show that these anti-inflammatories do not relieve lower back pain.

They also do not decrease the duration of low back pain.

On the other hand, they expose patients to side effects, even if the duration of treatment is short: insomnia, nervousness, infections, fractures, venous thrombosis… About half of patients are affected, according to the scientific literature.

The benefit/risk balance therefore leans against the oral form of these drugs in the event of acute or chronic low back pain.

The pain is slightly reduced

Are corticosteroid-based creams or infiltrations more effective and better tolerated?

With regard to ointments and other topicals, there again the literature is not convincing.

Epidural infiltrations of corticosteroids, that is to say an injection between the bones of the spine directly in contact with the nerves, are sometimes proposed in the event of low back pain accompanied by sciatica responsible for severe pain.

, explains Dr. Florian Bailly, rheumatologist and pain doctor at the Pitié-Salpêtrière hospital in Paris.

However, it is difficult to predict the effectiveness of this treatment.

While some people respond very well to it, others see a modest improvement in their pain.

The benefit would last between three and six weeks.

, notes the rheumatologist.

But like oral corticosteroids, infiltrations do not modify the natural history of lumbosciatica, which resolves spontaneously, in 90% of cases, within a few weeks.

Nevertheless, by reducing pain, even modestly, they can allow patients to get back in motion and resume physical activity.

This therapy requires a prescription and a realization by a doctor, because there are complications, such as bleeding, an imbalance of diabetes or hypertension for example.

It must therefore be discussed on a case-by-case basis.