Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis

Abstract

Objective To investigate the efficacy and tolerability of analgesic and adjuvant pain drugs typically administered in primary care for the management of patients with sciatica. Design Systematic review.Data source International Pharmaceutical Abstracts, PsycINFO, Medline, Embase, Cochrane Central Register of Clinical Trials (CENTRAL), CINAHL, and LILACS.Study selection Randomised controlled trials assessing the efficacy and tolerability of drugs versus placebo or other treatment for sciatica. Data extractionTwo independent reviewers extracted data and assessed methodological quality using the PEDro scale. Pain and disability outcomes were converted to a common 0 to 100 scale. Data were pooled with a random effects model, and the GRADE approach was used in summary conclusions.Results Twenty three published reports met the inclusion criteria. The evidence to judge the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antidepressants, anticonvulsants, muscle relaxants, and opioid analgesics ranged from moderate to low quality. Most of the pooled estimates did not favour the active treatment over placebo. The pooled results of two trials of corticosteroids (mean difference in overall and leg pain −12.2, 95% confidence interval −20.9 to −3.4) and a single trial of the anticonvulsant gabapentin for chronic sciatica (mean difference in overall pain relief −26.6, −38.3 to −14.9) showed some benefits but only in the short term. The median rate of adverse events was 17% (interquartile range 10-30%) for the active drugs and 11% (3-23%) for placebo. Trial limitations included failure to use validated outcome measures, lack of long term follow-up, and small sample size. ConclusionsAs 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.

Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis

“…Our findings differ from previous evidence on anticonvulsants for lumbar radicular pain, in which a 2012 BMJ review reported a treatment benefit of gabapentin based on a single trial. 15 One key reason for the difference in our review is the inclusion of a 2017 study that found pregabalin was no more effective than placebo in patients with sciatica. 30 Clinically, the prescription of anticonvulsants for back and neck pain, including radicular pain in primary care, has increased by 535% in the last 10 years.…”

“…Previous reviews were limited only to populations with chronic back pain, 14 and new evidence may affect conflicting and limited conclusions. 5,15 Therefore, this systematic review aimed to determine the efficacy and tolerability of anticonvulsants in the treatment of low back pain and lumbar radicular pain compared with placebo.…”

Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis

“…In cases in which wrist ROM was reported only as a percentage of the contralateral (normal) wrist, we converted percentages to a degree measurement based on normal physiologic ROM (normal values used: 85°flexion, 80°ex-tension, 85°supination, 80°pronation, 35°ulnar deviation, and 20°radial deviation) [7,28]. Means and standard deviations (SDs) were collected when reported; medians were used in place of means when the latter was not reported because these provide an acceptable alternate measurement for centrality [35]. Where data were reported only in graph format, GraphClick software [14] was used to extract the relevant values.…”

Identifying optimal treatment of common and complex sciatica pain

“…Sciatica is traditionally diagnosed within patients presenting with primary complaints of unrelenting sharp pain, which travels profusely down the leg. Cases of mild to moderate sciatica are witnessed but at a much rarer occurrence, with patients presenting with mild to moderate pain and paresthesias [1][2][3][4][5][6][7][8][9][10]. Ordinary patients may present with or without neurological deficits such as numbness and weakness of the leg and/ or foot, in more severe cases patients may present with foot weakness causing difficulty and/or inability to ambulate.…”