Effective treatment for sciatica has been hard to prove. There may be many reasons for this but recent research has attempted to analyse all the best studies and combine the results in a so-called meta-analysis. The research team from Bangor University looked at more than 120 studies comparing 21 different treatment strategies. What they found will surprise many doctors and patients alike.
Previous studies have often found little or no significant improvements between various treatment strategies. This understanding combined with the fact that most sciatica gets better over a few months all by itself has meant that usual medical treatment has been to reassure the patient, prescribe pain-killers, and send them on their way. This new study should change that approach.
The researchers from the North Wales Centre for Primary Care Research concluded that for the best overall outcome significant improvements followed disc surgery, epidural injections, nonopioid analgesia, manipulation and acupuncture although disc surgery and epidural injections were associated with some adverse effects. If the only consideration was pain relief then epidural injections helped as did certain anti-inflammatory drugs. The interventions that were shown not be effective were bed rest, certain strong pain killers (opioids like codeine), traction and some surgical procedures like discectomy. Lead researcher Ruth Lewis said ‘The most interesting finding was that opioids are not effective. The lack of effect is probably due to the type of pain you’re dealing with.’
What sciatica treatment should you try first?
The NHS Pathfinder helps identify what treatment is best and when to seek it out. First of all you need a thorough assessment and examination by a competent health care professional such as a GP, of course, but also a chiropractor, physiotherapist or osteopath. This first assessment is important to rule out serious diseases and nasty nerve problems that need more invasive treatment like surgery. Fortunately most sciatica problems respond well without surgery. Manual therapy, like manipulation, as well as acupuncture feature have been shown to be effective.
How you choose to be treated for sciatica will often depend on your personal preferences. Some people hate the idea of acupuncture needles. For others manipulation or drug treatments are not appealing. Fortunately there are many treatment options and usually a combination of the most effective ones should be tried first. This means consulting a practitioner who is happy to work as part of a team to get the best outcome. Here at Sundial we have chiropractors, physiotherapists and acupuncturists who work with the recommendations from your GP. For more information on back and leg pain go here.
Surgery for sciatica is usually only contemplated for patients with severe nerve compression, if symptoms don’t respond to conservative care or carry on getting worse in spite of treatment.