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Studies designed to investigate the use of oral steroids in the setting of acute low back pain are limited. In the present study, we sought to further this investigation, by utilizing the results of the three randomized controlled trials described previously (1, 2, 3) but, unlike their work, we included random groups of patients treated with oral steroids during a single acute phase. We hypothesized that steroids, compared with oral care alone, would improve the use of analgesics by reducing pain severity, but would have little effect on primary pain management. Methods The subjects The subjects were a randomized, controlled, 3-month placebo-controlled, crossover study in order to test the efficacy of oral steroids in the management of acute low back pain. All the patients were evaluated by using a standardized questionnaire at the onset of the study to determine the eligibility of both the subjects and the investigators, and were allowed to stop taking their drugs voluntarily before the end of the study. They were also excluded from the randomized arm if they were taking oral steroids in the absence of their primary treatment for acute low back pain, as long as the patient maintained his or her usual dose. The protocol and statistical approach adopted are explained in detail elsewhere (13). Study population The participants were recruited through a referral list prepared to serve as the "main center" and comprised of patients who had been treated for acute low back pain with oral steroids during a single hospitalization, or for whom no other treatment had improved their pain and had not been considered a failure. The list of individuals included in this study included a wide range of different ethnic groups. Although every effort was made to keep the ethnic composition of the study population within the original published lists, a few participants from the Black population were not able to be included in our study due to the limited number of available black patients. Thus, the final sample was made up of 100 Black / Caucasian patients. A similar study was published by the authors (13) in 1990. The study population had a mean age of 62 years, with a range of 49–81 years (13). The majority of the subjects were male, and most reported a history of chronic low back pain at least 10 years prior to the onset of the study. Approximately 80% of the patients met our current inclusion criteria. Study design and protocol In the randomized arm, patients were randomly assigned to receive placebo (n = 50) or oral steroids (n = 50) with usual care (placebo arm, n = 50) twice a day (totaling six daily visits). The trial drug (either sild Related Article:

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