The Natural Course of Acute Sciatica with Nerve Root Symptoms in a Double-Blind Placebo-Controlled Trial Evaluating the Effect of Piroxicam

Weber, Henrik; Holme, Ingar; Amlie, Even

doi:10.1097/00007632-199309010-00006

Cited by 254 publications

(88 citation statements)

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“…Chiropractic care, physical therapy, activity modifications and medications have shown efficacy in the treatment of acute low back pain [14][15][16]. There is, however, limited evidence to show their efficacy to treat chronic discogenic low back pain [17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Treatment of discogenic back pain with autologous bone marrow concentrate injection with minimum two year follow-up

Pettine¹,

Suzuki

Sand

et al. 2015

International Orthopaedics (SICOT)

107

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Section: Discussionmentioning

confidence: 99%

Treatment of discogenic back pain with autologous bone marrow concentrate injection with minimum two year follow-up

Pettine¹,

Suzuki

Sand

et al. 2015

International Orthopaedics (SICOT)

107

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“…The natural course of sciatica due to disc herniation is favourable [1,2] and the major management challenge at ®rst is adequate pain reduction [3]. Magnetic resonance (MR) imaging is the standard ancillary investigation.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of MRI findings in sciatica

2002

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The natural course of sciatica due to disc herniation is generally favourable but individually unpredictable. Some patients recover only after prolonged conservative therapy or surgery. This study aims to ascertain whether magnetic resonance (MR) imaging features can be used to predict outcome of sciatica and help to identify patients unlikely to respond to conservative management. For a transversal diagnostic study 274 primary care patients underwent early MR imaging for leg pain. One hundred and thirty-three patients with sciatica were followed for 3 months, both patients and physicians being unaware of MR imaging findings. At 12 weeks a favourable prognosis was indicated by the following features: annular rupture (P= 0.02) and nerve root compression on MR imaging (P = 0.03). Poor prognosis was indicated by disc herniation in the foramen (P = 0.004). Our findings show that early MR imaging features are related to prognosis. However, the associations are not strong enough to justify routine use of early MR imaging to predict the prognosis of sciatica.

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“…3,4 However, another cohort found that 55% still had symptoms of sciatica 2 years later, and 53% after 4 years (which included 25% who had recovered after 2 years but had relapsed again by 4 years). 5 Current care pathways in the NHS typically involve the prescribing of analgesia by the patient's general practitioner (GP) and, if troublesome symptoms persist, referral for physiotherapy either in community-based physiotherapy services, musculoskeletal interface services or secondary care spinal clinics.…”

Section: Discussionmentioning

confidence: 99%

“…At present between 5% and 15% of patients with sciatica undergo disc surgery. 3,4 In the NHS in England in 2013/14, 8330 lumbar discectomies were performed. 8 Based on a Dutch trial that indicated that the cost of sciatica to society represents 13% of all back pain-related costs, the annual impact on the UK economy is £268M in direct medical costs and £1.9B in indirect costs (inflated from 1998 figures).…”

Section: Discussionmentioning

confidence: 99%

“…8 Based on a Dutch trial that indicated that the cost of sciatica to society represents 13% of all back pain-related costs, the annual impact on the UK economy is £268M in direct medical costs and £1.9B in indirect costs (inflated from 1998 figures). 9 Sciatica caused by lumbar nerve root pain usually arises from a prolapsed intervertebral disc, 3 not only from compression of the nerve root, 10 but also the release of proinflammatory factors from the damaged disc. 11,12 Internal disc rupture that does not result in prolapse can also induce disabling radicular pain, 13 and the degree of disc displacement, nerve root enhancement and neural compression on magnetic resonance imaging (MRI) does not correlate with sciatic symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Subcutaneous Injection of Adalimumab Trial compared with Control (SCIATiC): a randomised controlled trial of adalimumab injection compared with placebo for patients receiving physiotherapy treatment for sciatica

Williams

Jenkins

Goulden

et al. 2017

Health Technol Assess

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Background Biological treatments such as adalimumab (Humira®; AbbVie Ltd, Maidenhead, UK) are antibodies targeting tumour necrosis factor alpha, released from ruptured intervertebral discs, which might be useful in sciatica. Recent systematic reviews concluded that they might be effective, but that a definitive randomised controlled trial was needed. Usual care in the NHS typically includes a physiotherapy intervention. Objectives To test whether or not injections of adalimumab plus physiotherapy are more clinically effective and cost-effective than injections of saline plus physiotherapy for patients with sciatica. Design Pragmatic, parallel-group, randomised controlled trial with blinded participants and clinicians, and an outcome assessment and statistical analysis with concurrent economic evaluation and internal pilot. Setting Participants were referred from primary care and musculoskeletal services to outpatient physiotherapy clinics. Participants Adults with persistent symptoms of sciatica of 1–6 months’ duration and with moderate to high levels of disability. Eligibility was assessed by research physiotherapists according to clinical criteria for diagnosing sciatica. Interventions After a second eligibility check, trial participants were randomised to receive two doses of adalimumab (80 mg and then 40 mg 2 weeks later) or saline injections. Both groups were referred for a course of physiotherapy. Main outcome measures Outcomes were measured at the start, and after 6 weeks’ and 6 months’ follow-up. The main outcome measure was the Oswestry Disability Index (ODI). Other outcomes: leg pain version of the Roland–Morris Disability Questionnaire, Sciatica Bothersomeness Index, EuroQol-5 Dimensions, 5-level version, Hospital Anxiety and Depression Scale, resource use, risk of persistent disabling pain, pain trajectory based on a single question, Pain Self-Efficacy Questionnaire, Tampa Scale of Kinesiophobia and adverse effects. Sample size To detect an effect size of 0.4 with 90% power, a 5% significance level for a two-tailed t-test and 80% retention rate, 332 participants would have needed to be recruited. Analysis plan The primary effectiveness analysis would have been linear mixed models for repeated measures to measure the effects of time and group allocation. An internal pilot study would have involved the first 50 participants recruited across all centres. The primary economic analysis would have been a cost–utility analysis. Results The internal pilot study was discontinued as a result of low recruitment after eight participants were recruited from two out of six sites. One site withdrew from the study before recruitment started, one site did not complete contract negotiations and two sites signed contracts shortly before trial closure. In the two sites that did recruit participants, recruitment was slow. This was partly because of operational issues, but also because of a low rate of uptake from potential participants. Limitations Although large numbers of invitations were sent to potential participants, identified by retrospective searches of general practitioner (GP) records, there was a low rate of uptake. Two sites planned to recruit participants during GP consultations but opened too late to recruit any participants. Conclusion The main failure was attributable to problems with contracts. Because of this we were not able to complete the internal pilot or to test all of the different methods for primary care recruitment we had planned. A trial of biological therapy in patients with sciatica still needs to be done, but would require a clearer contracting process, qualitative research to ensure that patients would be willing to participate, and simpler recruitment methods. Trial registration Current Controlled Trials ISRCTN14569274. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 60. See the NIHR Journals Library website for further project information.

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The Natural Course of Acute Sciatica with Nerve Root Symptoms in a Double-Blind Placebo-Controlled Trial Evaluating the Effect of Piroxicam

Cited by 254 publications

References 0 publications

Treatment of discogenic back pain with autologous bone marrow concentrate injection with minimum two year follow-up

Treatment of discogenic back pain with autologous bone marrow concentrate injection with minimum two year follow-up

Prognostic value of MRI findings in sciatica

Subcutaneous Injection of Adalimumab Trial compared with Control (SCIATiC): a randomised controlled trial of adalimumab injection compared with placebo for patients receiving physiotherapy treatment for sciatica

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