Oral steroids are widely recommended despite minimal evidence and a wide range of potential side effects. What are the risks and side effects of taking oral steroids, and who should take them?
Oral steroids, often known as corticosteroids, are anti-inflammatory drugs that are commonly used for a variety of orthopedic problems, including low back and neck pain. While these medications can help with pain and inflammation, they can also have major side effects that you should consider with your doctor.
Corticosteroids can be taken in a variety of methods, with injectable and oral versions being the most typically utilized for back pain. This page covers the fundamentals of oral steroids, which come in the form of tablets, capsules, or syrups.
How Oral Steroids Work
Oral steroids are intended to function similarly to the hormones secreted by your adrenal glands in reaction to stress and injury. Corticosteroids relieve inflammation by raising your body’s natural adrenal hormones over their typical levels. Corticosteroids also lower your immune system, which benefits patients with autoimmune diseases like rheumatoid arthritis but can potentially impair your ability to fight infection.
Oral Steroid Dosage for Back Pain
The following are some examples of oral steroids (generic names are mentioned first, followed by a brand name example in parentheses):
- Methylprednisolone (Medrol)
- Prednisone (Deltasone)
- Dexamethasone (Decadron)
Oral steroids are normally recommended for a short period of time—often one or two weeks. In most circumstances, you will start with the highest dose and gradually reduce it until you have no medication left.
- Take 7 oral steroid pills on day 1, 6 pills on day 2, and so on until you reach 1 pill each day. Then, at the conclusion of the week (or second week), you discontinue taking any medication.
Because of its potency and potential negative effects, oral steroids are administered in lower doses. More information is provided below.
Who Should Take Oral Steroids?
These drugs, when used for a shorter period of time, may help relieve the unpleasant inflammation associated with severe acute back and neck pain (pain that arises and resolves quickly, though it may last up to 3-6 months). Oral steroids may also help with the painful flare-ups that are prevalent in chronic inflammatory disorders like rheumatoid arthritis. Low back pain and herniated discs are two common disorders treated with oral steroids.
Oral Steroids Strengths and Weaknesses
One of the most significant advantages of oral steroids is that they provide pain and inflammatory relief without the invasiveness of their injectable counterparts. Oral steroids, unlike spinal injections, do not require an MRI or radiation exposure and may be less risky for some people. Spinal injections, on the other hand, give a more concentrated dose of corticosteroids with less systemic (whole-body) side effects.
However, there are certain disadvantages to using oral steroids. Oral versions of steroids take longer to take action than needles. Oral steroids, unlike intravenous steroids, affect the entire body rather than just one area. As a result, oral steroids have more severe adverse effects than other means of administration.
The following are possible adverse effects:
- 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 has long been assumed that short-term usage of oral steroids protects against more serious adverse effects. A recent study published in the BMJ in April 2017 discovered that adults taking oral steroids had a two-fold increased risk of fractures, a three-fold increased risk of venous thromboembolism, and a five-fold increased risk of sepsis within 30 days of beginning the prescription. The study authors advise taking the lowest feasible dose of oral steroid to avoid the risk of these complications.1 Furthermore, no well-designed studies have substantiated the efficacy of oral steroid medicines for neck and low back pain.
If oral steroids are needed for a lengthy period of time, such as in the treatment of certain inflammatory conditions (e.g., lupus, ankylosing spondylitis), you should be aware of the following side effects that may arise with chronic use:
- Increased skin bruising and slower wound healing
- Infection risk has increased.
- Vision clouding or blur
- High blood sugar levels
- Fractures with osteoporosis
- Bone avascular necrosis (death of bone due to lack of blood supply)
Safely Using Oral Steroids for Spine Pain
Oral steroids are only available with a prescription. Inquire with your doctor about the adverse effects and problems connected with these medications. Also, make sure you understand how to use your oral steroid correctly, as it may be on a tapering schedule rather than a straightforward one-pill-per-day plan.
To use your medication safely, follow the directions provided by your doctor. If you have any questions about using your oral steroid, contact your doctor or chat with your pharmacist when you pick up your prescription.
When other therapies have failed to relieve pain and inflammation in the back or neck (especially from a pinched nerve), oral steroids can be used as an adjuvant to reduce pain and inflammation, but they must be taken exactly as prescribed by your doctor to avoid potentially serious side effects. If you finish your medication course and discover that your pain is still interfering with your quality of life, talk to your doctor about other options (such as physical therapy, spinal injections, and so on).
In conclusion, it’s safe to assume that oral steroids is listed among the good options for back pain relief. These steroids can help you get relief from pain, but they do have side effects and risks. However, with the proper use and proper administration techniques, you won’t have to worry about the negative side effects. And even if you do, remember that these side effects are not permanent, and can be treated with the right solution.