Is there a safe dose of long-term steroids for back pain?

Last April, I had back surgery to enlarge the disc openings. Some of my problems were corrected with the surgery, but one major problem still exists: After I sit upright in a chair or drive a car for a period of time, when I attempt to get up, I struggle and have to wait a bit before I can walk away. It’s like a nerve is pinched when I sit. My doctor showed me my last MRI and pointed out some scar tissue. He said irritation of my sciatic nerve was causing my left leg to go numb. He prescribed a six-day course of steroids, and immediately after starting the steroids, I was cured. I could get up and walk after sitting; I put my cane and walker away, and life was good. After the steroids ran out, I was back to square one. I asked if he could prescribe more steroids for me, and he said his office doesn’t do that. Instead, he upped my gabapentin and added diclofenac. They are not helping. I am a 77-year-old retired cop, and I would like to finish my life still being able to golf, hunt, ride my motorcycle and fish. In short, I want to be in the game, not in the stands. Is there a safe dose of steroids that I could recommend to my doctor? — J.C.

DEARREADER » Steroids are very powerful anti-inflammatory medications that have multiple effects in the body, and although they are very useful, they have the potential for real harm. I could write over a months’ worth of columns on the side effects of prednisone and similar steroids, but for you, the main concerns would include loss of bone minerals, muscle weakness, diabetes, high blood pressure and even changes in mood and personality. Most of these changes occur only after fairly prolonged use of high-dose steroids, and that’s why your doctor doesn’t want to prescribe them long term (and I firmly agree with him).

That doesn’t mean you have to be “out of the game.”

The fact that the steroids worked so well so quickly indicates that inflammation is a big part of why your sciatic nerve is being compressed. You would be an excellent candidate for injection of steroid right to the area where the nerve is being irritated.

This is called an epidural injection, and it will hopefully help relieve the inflammation, leading to decreased numbness and other symptoms.

The booklet on back problems gives an outline of the causes of and treatments for the more-common back maladies. Readers can order a copy by writing: Dr. Roach Book No. 303 628 Virginia Dr. Orlando, FL 32803 Enclose a check or money order for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.