When an injury or other condition places internal pressure on the sciatic nerve, a large nerve which runs from the lower back down the back of each leg, it can result in tingling, weakness, numbness, discomfort, and even pain. Some patients may actually incur damage to the nerve itself, not just pressure, either from an injury like a pelvic fracture or slipped disk, or a foreign body like the growth of a tumor.

 

This sensation is referred to as sciatica, and as the past 10 years of research reveals, its potential treatment continues to evade much of the medical and holistic community. The BMJ (formerly known as British Medical Journal) stated in a 2017 guidelines report that over 4 million working days are lost worldwide due to back pain, and “More than 30% of people still have clinically significant symptoms after a year after onset of sciatica.”

Sciatica results from an underlying condition or injury, and is not a condition itself, however, the pain from sciatica can go so far as to disrupt day to day life and negatively impact work, parenting, school, and more. Anecdotally, sciatica sufferers may tout various remedies for their pain which seemingly transformed their lives for the better - yoga, steroid injections, narcotic pain killers, surgery, even the best brace for sciatica - but the jury is still out as to what the silver bullet for sciatica pain might be. What is becoming clear with recent research, however, is that pharmacological intervention with prescription drugs may do more harm than good. 

2015 randomized trial published in the Journal of the American Medical Association revealed that administration of the oral steroid prednisone versus a placebo resulted in no improvement in pain for patients with sciatica from a  herniated lumbar disk. Prednisone also only showed modest improved function in patients, and resulted in reports of more adverse reactions at a 3 week follow-up than in the placebo group.

The New England Journal of Medicine published a 2017 study which additionally showed less efficacy of a prescription drug versus a placebo. This time 209 sciatica patients participated in a randomized, double-blind, placebo-controlled trial of the drug pregabalin (Lyrica). Results disclosed that over the course of 8 weeks, patients taking pregabalin did not see improvements in pain or other outcomes, and were almost twice as likely to experience adverse events with taking the drug versus a placebo.

A systematic review and meta-analysis from The BMJ in 2011 cast a wider net on sciatica treatment looking at everything from non-steroidal anti-inflammatory drugs (NSAIDs) and antidepressants, to anticonvulsants, corticosteroids, muscle relaxants, and opioid analgesics. Its findings? 23 reports included in the review bore low to moderate quality evidence that revealed efficacy of drugs versus placebos was simply not clear. Only three studies revealed findings in the positive for prescribed sciatica management (corticosteroids and an anticonvulsant), however, pain relief for patients even then was short-lived.

When it comes to nonpharmacological paths towards pain relief, results still vary with methods including mindfulness practices, exercise, massage, spinal manipulation, and acupuncture. Limited evidence in a 2015 study found that acupuncture was more effective at treating sciatica pain than drugs, and could even possibly enhance the effect of drugs taken for sciatica. More rigorous methodology and clinically relevant outcomes in future studies, however, was needed to qualify this finding.

Most recently, a June 2017 study focused specifically on lumbar disk herniation and the practice of surgeons in treating associated sciatica. The group of researchers from the Netherlands surveyed over 800 surgeons across 89 countries and found that treatment practice varied greatly across the world when it came to lumbar disk herniation and that there is a “discrepancy between the eminence-based medicine and the evidence-based medicine in the treatment of LDH”.

Like with many treatment plans, the bottomline for sciatica management isn’t black and white. In fact, it’s almost too blurry to even make out the gray. What is known is that more thorough analysis and research is needed to formulate international guidelines to most optimally be able to treat sciatica patients effectively. The risky trade offs with treatments that may be no better than a placebo ultimately put patients in danger.

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