Medicine Today: With sciatica, knowing what doesn’t help helps, too

A pinched nerve in the back causing sharp pain down the leg can be a painful and disabling problem. This condition, called sciatica, affects 3 to 5 percent of adults at some point during their lives. Many medications have been tried to help with the symptoms, although a clear answer for sciatica isn’t known.

 

A new paper in the New England Journal of Medicine shows that a specific medicine called pregabalin doesn’t improve sciatica pain.

The spine is a bony structure that surrounds and protects the spinal cord. If you feel your back, the bumps you feel along your spine are individual vertebrae that make up your spine. Nerves that exit the spinal cord pass through a narrow opening between each vertebrae. These nerves provide sensation and function to your arms, legs and organs.

Sciatica, also called lumbosacral radiculopathy, occurs when nerves exiting the lower spinal cord become irritated and cause discomfort in one’s back and legs. The most common cause is compression of the nerve, or a pinched nerve. This compression often occurs when nerves pass through the narrow opening between vertebrae.

Most uncomplicated cases of sciatica, although initially painful, usually improve on their own with time. Although there are nuances, typical management is conservative with acetaminophen (Tylenol) and anti-inflammatory medications called NSAIDs (ibuprofen). If this doesn’t provide relief, opioids, steroids and pregabalin are used. Patients are encouraged to maintain light activities around the house as tolerated. Surgery is typically reserved for patients with persistent or worsening symptoms.

Dr. Christine Lin, an associate professor at The George Institute for Global Health in Australia, and colleagues studied 209 patients with sciatica. Approximately half of patients received pregabalin and the other half received a dummy pill that has no effect.

Researchers measured patient discomfort on a scale of 0 to 10 (higher number is more discomfort) in both groups at 8 weeks and 52 weeks after starting treatment. They found no significant difference between the two groups. At 8 weeks, patients who received pregabalin rated their discomfort at 3.7 versus 3.1 in the dummy-pill group. At 52 weeks, patients who received pregabalin rated their discomfort at 3.4 versus 3.0 in the dummy-pill group. At 52 weeks, the pregabalin group had 224 adverse events reported versus 124 in the dummy-pill group.

Lin and colleagues showed that pregabalin is not effective for the treatment for sciatica and is associated with a high rate of side effects. This well-performed study is relevant to many patients with sciatica.

Although at times the treatment of sciatica remains a mystery, Lin’s study tells us what may not work, which may be as important as what does work.

 

Anant Mandawat, a graduate of Lakeside High School and Yale University’s medical school, is a doctor of internal medicine at Massachusetts General Hospital.

 

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