Ibuprofen With or Without Dexamethasone for Acute Radicular Low Back Pain.

Inclusion Criteria:

• Present to ED primarily for management of acute radicular LBP, defined as pain orparesthesia originating from the lower back and radiating to the buttock and or legin a radicular pattern. Some patients may not have prominent LBP but a radicularsymptom--we will include these patients as well.

• Patient is to be discharged home.

• Age 18-70 Enrollment will be limited to adults <70 years because of the increasedrisk of adverse medication effects in older adults.

• Pain duration <2 week

• Prior to the acute attack of radicular LBP, back pain cannot occur more frequentlythan half of the days in the last 3 months. Patients with more frequent backpain/sciatica are at increased risk of poor pain and functional outcomes.10

• Non-traumatic cause of pain: no substantial and direct trauma to the back within theprevious month

• Functionally impairing radicular LBP: A baseline score of > 5 on the Roland-MorrisDisability Questionnaire

Exclusion Criteria:

• Not available for follow-up

• Pregnant

• Chronic pain syndrome defined as use of any analgesic medication on a daily ornear-daily basis

• Allergic to or intolerant of investigational medications

• Chronic steroid use

• Contra-indications to investigational medications: 1) known peptic ulcer disease,chronic dyspepsia, or history of gastrointestinal bleed 2) Severe heart failure (NYHA 2 or worse) 3) Chronic kidney disease (GFR <60ml/min) 4) Current use ofanti-coagulants 5) cirrhosis (Child Pugh A or worse) or hepatitis (transaminases 2xthe upper limit of normal)