New research shows that even short term oral steroids carry serious risk which may outweigh their reward. Oral steroids are most commonly used to treat inflammation related to upper respiratory tract infection, spinal pain, inter vertebral disc disorders, allergies, bronchitis, and lower respiratory tract disorders.
Corticosteroids are used to treat a number of conditions due to their strength in treating inflammation. It is been well known that there are sometimes serious adverse risks that come with taking oral steroids. What hasn’t been understood is what short term risks exists with taking oral steroids. Researchers are seeing higher rates of serious adverse events within 30 days of filling a prescription for an oral steroid. These researches recently published a study in the British Medical Journal to examine the adverse events associated with short term oral steroid use.
These researchers looked at a database that consisted of 1,548,945 adults aged 18 to 64 years and found that 327,452 (21.1%) received at least one outpatient prescription for short-term oral corticosteroids (30 or fewer days). Nearly half (46.9%) of recipients were prescribed a 6-day prepackaged methylprednisolone “dosepak,” which tapers the dose from largest to smallest over the 6 days. Within 30 days of drug initiation, there was an increase in incidence rate of sepsis, venous thromboembolism, and fracture. The increased risk persisted at prednisone equivalent doses of less than 20 mg/day. Based on their findings these researchers recommended prescribing the smallest possible amount of corticosteroids for treating the condition in question. They state, “If there are alternatives to steroids, we should be use those when possible. Steroids may work faster, but they aren’t as risk-free as you might think.”
What does this mean to you? I am not as well versed on all of the conditions that oral steroids are being used to treat my only experience is with spine and spine related conditions. In the managing of spine pain I don’t think the evidence shows the benefit outweighs the risk. In a previous blog post I report on a study which found that oral steroids were no better than placebo to treat sciatica. When you look at the published evidence what you get is that there is little benefit in using oral steroids for spine and spine related conditions like sciatica and some significant risk. When looking into whether or not oral steroids are the right treatment choice you have to ask yourself is the risk worth it for the benefit. If you are at the end of your rope with managing your spine pain, perhaps the risk is worth it, but if you are given a prescription for an oral steroid as your first treatment option I would say that the risk is greater than the potential benefit and go see a chiropractor instead.