Systemic glucocorticosteroids for degenerative back pain: efficacy in radiculopathy and musculoskeletal pain syndrome

Degenerative spinal disease can manifest as musculoskeletal pain and radiculopathy. Annual global incidence of symptomatic degenerative lumbar spine disease is approximately 266 million cases. This pathology is based on intervertebral disc degeneration. Key factors are pro-inflammatory cytokines, activation of metalloproteinases and mechanotransduction via Piezo1 channels. This review analyzes pathogenetic mechanisms of degenerative spinal disorders and evaluates efficacy and safety of systemic glucocorticosteroids in degenerative spinal pain. Despite the ability of glucocorticosteroids to suppress key inflammatory mediators, their clinical efficacy is limited (only transient improvement in radiculopathy, no advantage over NSAID therapy in musculoskeletal pain, and no effect in spinal stenosis). Concurrently, there is a risk of severe complications in high-risk patients (hypertension, diabetes mellitus) even in short-term treatment. Systemic glucocorticosteroids are not recommended for degenerative back pain due to unfavorable benefit / risk profile.