This blog will be short! I am at home on my back with acute sciatica – I have never felt pain like it and am extremely limited in what I am able to do. Standing is virtually impossible and the most comfortable position is lying flat where I can just about manage to balance my laptop in order to deal with a little work. At its worst I visited my GP who prescribed an array of medications including non-steroidal anti-inflammatory drugs, an opiate-based painkiller and a muscle relaxant. I was delighted and took what was prescribed diligently. Infuriatingly, although the intense pain subsided over the next day or two I was still left with a substantial amount of pain and was unable to stand. As an enquiring practitioner with time on my hands I decided to explore and appraise the evidence related to the treatment of sciatica. I found chat board after chat board where people described painful, long lasting and difficult to treat symptoms with lots of advice from fellow sufferers. I was shocked to find very little good quality scientific evidence available. One recent article in the BMJ1, a systematic review and meta-analysis of the drugs used to relieve pain in patients with sciatica concluded: As the existing evidence from clinical trials is of low quality, the efficacy and tolerability of drugs commonly prescribed for the management of sciatica in primary care is unclear. They also state:
Only low quality evidence to judge the efficacy and tolerability of drugs commonly prescribed for the management of sciatica in primary care. The available evidence does not clearly show favourable effects of NSAIDs, corticosteroids, antidepressants, or opioid analgesics in the immediate term, even compared with placebo.
There is much work to be done in this area and many people are suffering and perhaps taking unnecessary medications with potent side-effects and little impact. I will sign off now as I’m off to see the physio. This intervention does appear to have some success. I look forward to hearing your story.
1 Pinto, Rafael Zambelli, Maher, Christopher G, Ferreira, Manuela L, Ferreira, Paulo H, Hancock, Mark J, Oliveira, Vinicius C, McLachlan, Andrew J, Koes, Bart, . BMJ Publishing Group; 2012. Drugs for relief of pain in patients with sciatica : systematic review and meta-analysis. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278391/ accessed 24.1.13