Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis
BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e497 (Published 13 February 2012) Cite this as: BMJ 2012;344:e497
- Rafael Zambelli Pinto, PhD student1,
- Chris G Maher, director1,
- Manuela L Ferreira, research fellow1,
- Paulo H Ferreira, senior lecturer2,
- Mark Hancock, senior lecturer23,
- Vinicius C Oliveira, PhD student4,
- Andrew J McLachlan, professor5,
- Bart Koes, professor6
- 1George Institute for Global Health, University of Sydney, PO Box M201, Camperdown, Sydney, NSW, 2050, Australia
- 2Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney
- 3Faculty of Human Sciences, Macquaire University, Sydney
- 4Faculty of Health Sciences, University of Sydney, Sydney
- 5Faculty of Pharmacy, University of Sydney, Centre for Education and Research on Ageing, Concord Hospital, Sydney
- 6Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, Netherlands
- Correspondence to: R Z Pinto rafaelzambelli{at}gmail.com
- Accepted 21 November 2011
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.
Footnotes
Contributors: RZP, CGM, BK, PHF, MLF, MH, and AJM were involved in the design of the review. RZP, MLF, PHF, and VCO developed the search strategy and performed the study selection. RZP, MH, AJM, and VCO extracted data from included studies. RZP, CGM, BK, AJM, and VCO were involved in data analysis. RZP, CGM, BK, PHF, MLF, and MH were involved in the interpretation and discussion of results. All authors contributed to the writing and review of the various drafts of the report. RZP and CGM are guarantors.
Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. RZP is supported by Capes Foundation, Ministry of Education of Brazil. CGM is supported by a research fellowship funded by the Australian Research Council.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: Nor required.
Data sharing: No additional data available.
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