Oral Corticosteroid Therapy in Lumbar Radiculopathy: Evidence From Randomized Controlled Trials

Oral corticosteroids are frequently prescribed for lumbar radicular pain, despite uncertainty regarding their clinical benefit. Electronic databases, including MEDLINE, Embase, CENTRAL, Scopus, and PubMed, were searched from inception to identify randomized controlled trials assessing oral corticosteroids for lumbar radicular pain. The primary outcome was functional improvement, while secondary outcomes included pain intensity, quality of life, patient-reported improvement, need for surgery, and adverse events. Risk of bias was assessed using the Cochrane RoB 2 tool, and due to heterogeneity across studies, results were synthesized narratively. Four trials involving 369 participants were included. One placebo-controlled trial demonstrated a modest but statistically significant improvement in disability with oral corticosteroids, without a corresponding reduction in pain intensity. Two additional placebo-controlled trials found no significant between-group differences in pain or function. An active-comparator trial reported lower pain scores with oral corticosteroids compared with pregabalin or gabapentin, although interpretation was limited by methodological concerns. Quality-of-life outcomes were inconsistent, rates of surgery did not differ between groups, and oral corticosteroids were associated with more frequent short-term adverse events. Overall, oral corticosteroids may provide modest functional benefit in lumbar radiculopathy but do not consistently reduce pain or the need for surgery and are associated with increased short-term adverse effects, indicating that their use should be individualized with careful consideration of potential benefits and harms.