Clinical Context

Sciatica is a common pain condition seen in primary care and specialist offices alike, and it carries a worse prognosis in recovery vs low back pain. The authors of the current study provide a brief review of research examining rates of recovery from sciatica. Overall, rates of recovery are fairly variable in comparing different results from different studies. However, in 2 large trials, the rates of recovery from sciatica after surgery were approximately 70% to 80% at 1 year, whereas the rate of recovery without surgery was only 56% to 60%. Moreover, patients treated without surgery did not experience substantial gains in the rate of recovery after 1 year.

Sciatica

A better understanding of which patients with sciatica are at risk for poor outcomes can help clinicians in medical decision making. The current study by Haugen and colleagues addresses this issue.

Study Synopsis and Perspective

Prognostic factors associated with nonsuccess in patients with sciatica and disc herniation are recently identified in those referred to secondary care. These factors include being male, smoking, and having comorbid health complaints, according to the findings of a prospective, observational study.

Anne J. Haugen, MD, with the Department of Rheumatology at the Østfold Hospital Trust in Fredrikstad, Norway, and colleagues reported their findings in the September 22 issue of BMC Musculoskeletal Disorders.

"The results indicate that the prognosis for sciatica referred to secondary care is not that good and only slightly better after surgery and that comorbidity should be assessed in patients with sciatica," the researchers write.

According to Dr. Haugen and colleagues, existing data on prognosis and success rates for patients with sciatica are variable and come largely from studies evaluating surgical outcomes. Their primary goal was to identify prognostic factors associated with nonsuccess at 1- and 2-year follow-up in patients treated both nonoperatively (ie, conservatively) and surgically.

The multicenter study included 466 patients with sciatica and lumbar disc herniation who were referred for secondary care from primary health services in 2005 and 2006. Disc herniation was confirmed with imaging, and referral to an orthopaedic surgeon was made by the back clinic if symptoms were "severe."

Prognostic factors recorded at inclusion included age, sex, smoking status, educational level, and work status. The researchers also recorded duration and severity of back and leg pain and previous episodes of sciatica.

Patients completed questionnaires and underwent clinical examination at baseline. Questionnaires were then completed at 3, 6, 12, and 24 months. The main outcome variable was the Maine-Seattle Back Questionnaire (MSBQ) score, which the study authors report as the best measure of success in sciatica. The MSBQ assesses disability and functional limitations because of back pain and sciatica, with a higher score indicating worse function. Nonsuccess was defined as an MSBQ score of 5 or greater.

The secondary outcome measure was the Sciatica Bothersomeness Index (SBI), which assesses sciatica symptoms. Nonsuccess was defined as an SBI score of 7 or greater. Patient-reported variables included evaluations of emotional distress, kinesiophobia, motor function, sciatica symptoms, and a comorbid subjective health complaints inventory.

The study authors reported a nonsuccess rate of 47% at 1 year and 39% at 2 years in patients treated conservatively, when using the primary outcome. They also reported a nonsuccess rate of 35% at 1 year and 39% at 2 years in the surgical group.

Nonsuccess defined by the secondary outcome was reported in 54% of patients treated nonsurgically at 1 year and 47% at 2 years. By contrast, the nonsuccess rate in the surgical group was 30% at 1 year and 33% at 2 years.

Prognostic factors associated with nonsuccess at 1 year were male sex, smoking, higher intensity of back pain, and abnormal reflexes on examination. At the 2-year follow-up, kinesiophobia and longer duration of back pain and sciatica were considered prognostic factors for nonsuccess. A high score on the comorbid subjective health complaints assessment was associated with nonsuccess at both 1- and 2-year follow-ups, whereas nonsuccess in men and in surgical patients are contradictory to previous findings.

"The current results suggest that the prognosis for sciatica patients referred to secondary care is not as good as previously reported and is only slightly better after surgery, and that comorbidity and kinesiophobia should be assessed in patients with sciatica, including surgical candidates," the researchers conclude.

These findings call for "a broader assessment of patients with sciatica than is afforded by the traditional clinical assessment in which mainly the physical symptoms and signs are investigated," they suggest. "The results of the present study may be used to identify subgroups of patients referred to hospital with an increased risk of poor prognosis for sciatica."

The study was funded by a grant from the Eastern Norway Regional Health Authority. The study authors have disclosed no relevant financial relationships.

BMC Musculoskelet Disord. Published online September 22, 2012.

Source Medscape.org
Gout - Definition, Diagnosis and Treatment
09 Dec 2017 11:05 - VNPainGout - Definition, Diagnosis and Treatment

DEFINITION Gout is a term used to refer to a group of disease states caused by tissue deposition of monosodium urate due to prolonged hyperuricemia. Clinical manifestations of gout include acu [ ... ]

A National Campaign Calls for Investment in Pain Research and Access to Pain Therapies- Pain News
08 Sep 2016 02:35 -

By Ed Coghlan The nation’s largest pain patient advocacy group has launched a campaign called “People With Pain Matter”. The U.S. Pain Foundation wants to  raise public awareness of the impact  [ ... ]

Children and Pain: Acupuncture Provides Pain Relief for Kids with Chronic Conditions- Pain News
08 Sep 2016 02:35 -

By Staff Acupuncture appears to be an effective pain management tool for children who have chronic medical conditions, according to a study published by Gillette Children’s Specialty Healthcare. Th [ ... ]

FDA Approves Biologic Drug to Treat Several Forms of Arthritis, Ankylosing Spondylitis and Plaque Ps...
08 Sep 2016 02:35 -

By Staff People who suffer from Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis and Plaque Psoriasis just got some good news:  A new drug called Erelzi just received FDA approval to [ ... ]

How Our Stuff Might Be Making Us Sicker- Pain News
08 Sep 2016 02:35 -

Donna Gregory Burch Lately I’ve been wondering if our material possessions could play a role in our fibromyalgia symptoms. My ruminating started a few months ago when the KonMari craze was at its pe [ ... ]

My Passion for Distraction- Pain News
08 Sep 2016 02:35 -

By Cynthia Toussaint I’ve been using distraction as my #1 painkiller for 34 years without knowing it. Now that I’ve come to  understand the power of intuitive healing, I want to shout it to the w [ ... ]

A Mother/Daughter/Advocate On Why She Fights for Chronic Pain Patients- Pain News
31 Aug 2016 07:24 -

By Ed Coghlan Terri Lewis, PhD is another chronic pain advocate that is working to make a difference for people like her son, who suffers from chronic pain. The National Pain Report asked her for a fe [ ... ]

DEA Moves on Kratom Classification- Pain News
31 Aug 2016 07:24 -

by Ed Coghlan The Drug Enforcement Administration (DEA) is continuing to try and squeeze what it believes are addictive drugs and properties.  Today it announced its intention to place the active mat [ ... ]

New Direction for Painkiller Research: Target Opioid Receptors Outside of the Brain to Reduce Side E...
31 Aug 2016 07:24 -

By Staff There may be a new direction in the development of opioid medication after researchers discover a different target for opioid receptors in the brain.  Most opioid pain medications target wha [ ... ]

Opiate Tolerance – FACT OR FICTION- Pain News
31 Aug 2016 07:24 -

By Steve Ariens, Ph.D. We often hear about chronic pain patients need to increase their dosage because of tolerance to their medication(s). Many of the people that put out all these “facts” tend t [ ... ]

Relief for Stroke Survivors with Shoulder Pain- Pain News
31 Aug 2016 07:24 -

By Ed Coghlan Up to 85% of stroke survivors suffer from chronic shoulder pain and that pain often stops them from continuing their efforts to rehabilitate after their stroke. When a stroke survivor ca [ ... ]

A Loved One’s Advocacy to Fight Chronic Pain- Pain News
23 Aug 2016 01:58 -

By Ed Coghlan Since we founded the National Pain Report, we’ve met a number of people whose loved ones suffer from chronic pain and advocate for them and the millions of others. One of them is retir [ ... ]

Midwest Pain Treatment Education Expo-Big Dreams Come to Life- Pain News
23 Aug 2016 01:58 -

By Gracie Bagosy-Young Editor’s Note- Saturday August 13, the Midwest Pain Treatment Education Expo was held near Chicago. It started three years ago as an idea by chronic pain activist Gracie Bagos [ ... ]

Researchers Create “Unprecedented, Weird and Cool” Opioid Painkiller from Scratch- Pain News
23 Aug 2016 01:58 -

By Staff Researchers from U.C. San Francisco, Stanford University, the University of North Carolina and the Friedrich-Alexander University Erlangen-Nürnberg have cooked up a new opioid drug candidate [ ... ]

3rd Annual US Pain Summit- Pain News
19 Aug 2016 07:23 -

By Katie M. Golden Making your way in the world today Takes everything you’ve got; Taking a break from all your worries Sure would help a lot. Wouldn’t you like to get away? Sometimes you want to  [ ... ]

Research Finds Link Between Dry Eyes and Chronic Pain- Pain News
19 Aug 2016 07:23 -

By Tara Heath Dry eye is a medical condition suffered by those whose eyes either don’t produce sufficient tears or they are of poor quality. Without sufficient lubrication for these eyes, they are a [ ... ]

Scientists Target Brain Cells to Alleviate Neuropathic Pain- Pain News
19 Aug 2016 07:23 -

By Staff More than one million Americans have neuropathic pain. Wouldn’t it be a good thing if that pain could be reduced or even eliminated? Scientists at Rutgers University think that targeting br [ ... ]

Why Are You Stiff in the Morning? New Discovery May Help Improve Treatment of Painful Inflammatory D...
19 Aug 2016 07:23 -

By Staff A protein created by the body’s “biological clock” (circadian) that actively represses inflammatory pathways during the night is responsible for that stiffness many feel in the morning, [ ... ]

DEA Doesn’t Budget on Marijuana Classification but Relents (A little) on Research- Pain News
14 Aug 2016 07:46 -

By Ed Coghlan If the medical benefits of marijuana are going to be approved by the federal government, it won’t happen while Barack Obama is President. The Drug Enforcement Administration declared m [ ... ]

Last Day to Sign the National Pain Strategy Petition- Pain News
14 Aug 2016 07:46 -

By Ed Coghlan Friday August 12 is the deadline to sign a petition that urges the White House to direct the Department of Health and Human Services to fund the National Pain Strategy. (To Sign The Peti [ ... ]

Other Articles

Comments