Patientsʼ Own Accounts of Sciatica

Abstract

STUDY DESIGN.: Longitudinal qualitative interview study, nested within a back pain cohort study. OBJECTIVE.: Enhance the understanding of patients' own perspectives on living with sciatica to inform improvements in care and treatment outcomes. SUMMARY OF BACKGROUND DATA.: Reports of patients' own accounts of sciatica and its impact on daily life are still scarce. Research on back pain has shown that it is important to understand how people live with pain and how they perceive interactions with health care professionals and interpret interventions. These types of insights help to improve treatments and their acceptability to patients. METHODS.: In-depth qualitative interviews with 37 people at baseline and 6 and 12 months' follow-up. The interviews covered topics that were derived from the Illness Perceptions Questionnaire and allowed open-ended talk about people's experiences of pain. All interviews were tape-recorded, fully transcribed, and thematically analyzed. RESULTS.: People needed to make sense of sciatica through identifying a cause and having it clinically diagnosed. The impact of sciatic pain was seen to be constant, intense, and all-encompassing. Appreciation of this by clinicians was considered important, as well as the provision of clear information about treatment and prognosis. Expectations about treatment options varied between patients, and people balanced pain relief with adverse effects. CONCLUSION.: Our study highlights patients' own accounts of the distinctiveness, impact, and intrusiveness of their sciatic symptoms. Our findings emphasize the importance of leg pain in identifying a subgroup of back-pain patients more likely to have severe symptoms, be at risk of poor outcome, and who should be considered a priority for early diagnosis and management. Future management of sciatica needs to include listening to patients' stories, offering a credible physical assessment, explanation, and diagnosis of the condition. Explaining the limits to treatment is seen as positively contributing to the partnership between patients and clinicians.

Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial

“…Stage 1 requires the respondents to list up to five important areas of life affected by their LBP. This is facilitated by the provision of a 'trigger list' generated for the target condition: 134 a 17-item trigger list was created, informed by qualitative evidence of the impact of LBP, 63,64,140,141 items included in widely used LBP-specific measures 63,65 and recent application of the PGI in a Norwegian LBP population 113 (Box 9).…”

Low back pain patients' beliefs about effective/ineffective constituents of a counseling intervention: a follow-up interview study

“…Qualitative research has indicated that LBP patients search and try to determine objective reasons for their pain [28,29]. They may use medical terminology to further legitimize their explanations [30], which in some situations will be in conflict with their personal experiences [31]. The majority of the participants in the present study had vague and general explanations of their illness, which could indicate that they at the time of interviewing were no longer in a position dominated by intense needs for legitimizing their LBP problems by referring to medical tests and terminology.…”

The clinical and cost-effectiveness of stratified care for patients with sciatica: the SCOPiC randomised controlled trial protocol (ISRCTN75449581)

“…Qualitative research on patients’ experiences of sciatica and its management is scarce [46, 47], especially in those with most severe symptoms, and qualitative studies that report clinicians’ views of managing this condition are even less common [48]. In the SCOPiC trial stratified care arm the ‘fast-track’ pathway to spinal specialist assessment and opinion is novel, and the focus of the qualitative study is on patients in this subgroup and the clinicians involved in their management.…”

“…We previously interviewed patients with sciatica and they highlighted its impact, the need for clearer information on treatment and prognosis and patients’ willingness to balance their desire for pain relief with adverse effects [46]. Whilst planning the SCOPiC trial we held a workshop with three patient representatives (who currently had sciatica or had suffered with it in the past) from a research user group.…”