Systematic review and meta-analysis

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e497 (Published 13 February 2012)
Cite this as: BMJ 2012;344:e497

Sciatica is considered to be a prognostic indicator of poor outcome among patients with low back pain. Furthermore a substantial proportion continuing to have persistent pain for two years or longer. General practitioners often prescribe pain-relieving drugs for patients with sciatica. While guidelines provide clear recommendations for the prescription of drugs for non-specific low back pain, this is not the case for sciatica. Commonly prescribed drugs for the management of sciatica include non-steroidal anti inflammatory drugs (NSAIDs), skeletal muscle relaxants, opioid analgesics, benzodiazepines, systemic corticosteroids, antidepressants, and anticonvulsants.

This review investigated the efficacy of analgesic and adjuvant pain drugs typically administered in primary care for the management of patients with sciatica. From 197 initial articles, 23 were fully reviewed. The included trials investigated six different classes of drugs: NSAIDs, antidepressants, corticosteroids, opioid analgesics, muscle relaxants, and anticonvulsants.

The results of this review show that there is low quality evidence for the efficacy of NSAIDs, corticosteroids, and anticonvulsants. Furthermore, the available evidence does not clearly show favorable effects of NSAIDs, corticosteroids, antidepressants, muscle relaxants, and opioid analgesics in the immediate term and provides limited support for the use of NSAIDs, corticosteroids, and anticonvulsants in the short term. At present these data provide a lack of conclusive and high quality evidence to endorse the prescription of these drugs for patients with sciatica in primary care. > From: Zambelli et al., BMJ 344 (2012) e497. All rights reserved to BMJ.

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