November 30, 2024
Efficacy of Naproxen in Patients With Sciatica
TAKE-HOME MESSAGE
- This randomized placebo-controlled trial involving 123 participants evaluated the efficacy of naproxen in treating patients with sciatica. The primary outcome of interest was daily leg pain intensity measured on a numeric rating scale. Secondary outcomes included pain measurement on other pain rating scales, the ability to work or study as usual, rescue medication use, and opioid use. Compared with placebo, naproxen use was associated with a small decrease in pain intensity on pain rating scales. There was no difference between the two groups in the consumption of rescue medications or opioids and in the ability to work or study.
- Clinicians should consider other medications for sciatic-related pain, given that these results are not likely to be clinically significant.
Abstract
This trial assessed the efficacy of naproxen in patients with sciatica in outpatient clinics across 4 Norwegian hospitals. A total of 123 adults with radiating pain below the knee (≥4 on a 0-10 numeric rating scale) and signs consistent with nerve root involvement were included. Participants were randomized to receive either naproxen 500 mg or a placebo twice daily for 10 days. The primary outcome, daily leg pain intensity measured on a 0 to 10 numeric rating scale throughout the treatment period, revealed a statistically significant difference in favor of naproxen, with an adjusted mean difference of -0.5 (95% CI -0.8 to -0.1, P = 0.015). In the naproxen group, the treatment effect was significantly related to time, and over the whole 10-day period, the average adjusted difference was -0.6 (95% CI -0.8 to -0.5). Mean numbers needed to treat for 30% and 50% improvement were 9.9 (95% CI 4.7-15.0) and 20.7 (8.7-32.7), respectively. The adjusted mean difference for back pain was -0.4 (95% CI -0.8 to 0.0), and for Roland Morris Disability Questionnaire for Sciatica, it was -1.5 (95% CI -3.0 to 0.0). No differences were found for sciatica bothersomeness or consumption of rescue medication or opioids. Participants in the naproxen group exhibited an adjusted odds ratio of 4.7 (95% CI 1.3-16.2) for improvement by 1 level on the global perceived change scale. In conclusion, naproxen treatment showed small, likely clinically unimportant benefits compared with placebo in patients with moderate-to-severe sciatica.