Foto original de Vicente Baos
- Llevo varios días con este dolor y no se me acaba de quitar, ¿por que no mi pincha ya algo? Ha venido un chico joven a revisarme el gas y me ha escrito en este papel lo que le pusieron a él y le fue magnífico.
Esta conversación real la he tenido en varias ocasiones con diferentes matices, todos laudatorios para el uso inyectado intramuscularmente de la combinación de 4mg de dexametasona, 60mg de lidocaína junto a tiamina y cianocobalamina. La utilización de corticoesteroides ha sido y sigue siendo controvertida en la lumbalgia aguda.
El UpToDate nos ilustra en Treatment of Acute Low Back Pain:
Glucocorticoids — There are remarkably few clinical trials that specifically address the use of systemic steroids for acute low back pain. A number of small, early trials had negative findings for the effectiveness of systemic steroids for radicular pain, but the sample sizes were small. A subsequent trial found only transient pain reduction with bolus intravenous methylprednisolone for patients with radicular findings. A small randomized placebo-controlled trial of parenteral methylprednisolone in patients presenting to the emergency department with non-traumatic low back pain and a negative straight leg raise found no benefit. The 2007 joint guidelines from the ACP and APS recommend against use of systemic glucocorticoids because of lack of proven benefit over placebo.In light of these findings, we do not recommend systemic corticosteroids in acute low back pain. If they are used, especially in high doses, patients should be advised of adverse effects, particularly insomnia, mood lability, and poor glycemic control in those with diabetes
o bien en Acute Lumbosacral Radiculophaty: Prognosis and Treatment:
Systemic glucocorticoids — In the clinical experience of some of the authors, systemic glucocorticoid treatment may provide partial pain relief for select patients with acute lumbosacral radiculopathy. However, it has not been evaluated for this indication in large randomized controlled trials. The available evidence from small trials suggests that systemic glucocorticoid therapy has either limited benefit or no benefit. A 2007 practice guideline from the American Pain Society and the American College of Physicians reviewed four small trials and concluded that systemic glucocorticoids are ineffective for low back pain with sciatica (ie, with radicular symptoms). A 2012 meta-analysis of three small trials in patients with acute sciatica concluded that pooled estimates showed no effect of glucocorticoids in the immediate term (two weeks or less after randomization) but a significant benefit of glucocorticoids in the short term (two weeks to three months from randomization). The quality of evidence was considered moderate.Acknowledging that any benefit is likely modest, one author of this topic sometimes employs a course of oral prednisone (60 to 80 mg daily) for five to seven days for patients with acute lumbosacral radiculopathy who do not respond well to analgesics and activity modification. This is followed by a rapid taper to discontinuation over the following 7 to 14 days. However, the other authors generally do not use systemic glucocorticoids in this setting.Major side effects associated with systemic glucocorticoids include elevated blood pressure, mood disorders, psychosis, insomnia, gastritis, ulcer formation, gastrointestinal bleeding, hyperglycemia, bone loss, and heightened risk of typical infections. Some of these side effects are both dose and duration dependent, and are more likely to occur with long-term glucocorticoid use.Patients taking glucocorticoids in combination with NSAIDs may require prophylaxis against gastrointestinal bleeding.
Sin embargo, la experiencia subjetiva de los pacientes que han usado el medicamento es muy positiva, y he de reconocer que es así cuando he optado por utilizarlo. ¿Efecto placebo? ¿Efecto "es que lo pinchado es mucho mejor"?