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Cited by 213Musculoskeletal pain and rehabilitationPain Mechanisms and TreatmentsSpine and Intervertebral Disc Pathology

Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis

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Pinto, R. Z., Maher, C. G., Ferreira, M. L., Ferreira, P. H., Hancock, M., Oliveira, V. C., McLachlan, A. J., Koes, B.·2012·BMJ
DOI 10.1136/bmj.e497PMC PMC3278391
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Abstract

OBJECTIVE: To investigate the efficacy and tolerability of analgesic and adjuvant pain drugs typically administered in primary care for the management of patients with sciatica. DESIGN: Systematic review. Data source International Pharmaceutical Abstracts, PsycINFO, Medline, Embase, Cochrane Central Register of Clinical Trials (CENTRAL), CINAHL, and LILACS. STUDY SELECTION: Randomised controlled trials assessing the efficacy and tolerability of drugs versus placebo or other treatment for sciatica. DATA EXTRACTION: Two independent reviewers extracted data and assessed methodological quality using the PEDro scale. Pain and disability outcomes were converted to a common 0 to 100 scale. Data were pooled with a random effects model, and the GRADE approach was used in summary conclusions. RESULTS: Twenty three published reports met the inclusion criteria. The evidence to judge the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antidepressants, anticonvulsants, muscle relaxants, and opioid analgesics ranged from moderate to low quality. Most of the pooled estimates did not favour the active treatment over placebo. The pooled results of two trials of corticosteroids (mean difference in overall and leg pain -12.2, 95% confidence interval -20.9 to -3.4) and a single trial of the anticonvulsant gabapentin for chronic sciatica (mean difference in overall pain relief -26.6, -38.3 to -14.9) showed some benefits but only in the short term. The median rate of adverse events was 17% (interquartile range 10-30%) for the active drugs and 11% (3-23%) for placebo. Trial limitations included failure to use validated outcome measures, lack of long term follow-up, and small sample size. CONCLUSIONS: As the existing evidence from clinical trials is of low quality, the efficacy and tolerability of drugs commonly prescribed for the management of sciatica in primary care is unclear.

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Authors
Pinto, R. Z., Maher, C. G., Ferreira, M. L., Ferreira, P. H., Hancock, M., Oliveira, V. C., McLachlan, A. J., & Koes, B.
Affiliations
  • The University of Sydney (AU)
  • Erasmus MC (NL)
Corresponding author
Pinto, R. Z.
ORCID
Venue
BMJ
Publisher
BMJ
Published
2012-02-13
Volume
344
Issue
feb13 1
Pages
e497-e497
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.e497
PMC
PMC3278391
OpenAlex
W2110709740
Cited by
213
References
10
Citations by year
2026: 7 · 2025: 11 · 2024: 9 · 2023: 21 · 2022: 14 · 2021: 23 · 2020: 14 · 2019: 16 · 2018: 16 · 2017: 18 · 2016: 15 · 2015: 17 · 2014: 16 · 2013: 8 · 2012: 8
FWCI
1.79
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
Keywords
sciatica, analgesics, adjuvant analgesics, nonsteroidal anti-inflammatory drugs, corticosteroids, antidepressants, antiepileptic drugs, gabapentin, muscle relaxants, opioid analgesics, analgesia, drug tolerability, adverse events, chronic sciatica, primary care
MeSH terms
Adrenal Cortex Hormones, Analgesics, Opioid, Anti-Inflammatory Agents, Non-Steroidal, Anticonvulsants, Antidepressive Agents, Humans, Neuromuscular Agents, Sciatica, Confounding Factors, Epidemiologic, Randomized Controlled Trials as Topic, Treatment Outcome, Evidence-Based Medicine

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