Back Pain - Sciatica
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- General Information
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- Internet Sites
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- Risk Reduction
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Back Pain - Sciatica
NIH - Medical Encyclopedia Back pain - low
"The specific structure in your back responsible for your pain is hardly ever identified. Whether identified or not, there are several possible sources of low back pain: • Small fractures to the spine from osteoporosis • Muscle spasm (very tense muscles that remain contracted) • Ruptured or herniated disk • Degeneration of the disks • Poor alignment of the vertebrae • Spinal stenosis (narrowing of the spinal canal) • Strain or tears to the muscles or ligaments supporting the back • Spine curvatures (like scoliosis or kyphosis) which may be inherited and seen in children or teens • Other medical conditions like fibromyalgia. "
Highlighted Article
Treatment of acute sciatica. (Am Fam Physician. 2007)
"Acute sciatica is lower back pain with radiculopathy below the knee and symptoms lasting up to six weeks. … caused by a variety of conditions: disk herniation, lumbar spinal stenosis, facet joint osteoarthritis or other arthropathies, spinal cord infection or tumor, or spondylolisthesis. … Clinical Commentary: An efficient clinical history and thorough physical examination of a patient with suspected sciatica is needed to rule out urgent conditions like cauda equina syndrome, infection, or cancer, and to determine the need for diagnostic tests. After the acute episode, emphasis is placed on activity, back exercises, behavioral techniques, ergonomics education, and close clinical monitoring. Educating patients on self-care and establishing reasonable expectations usually increase patient compliance with therapy and improve satisfaction."
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Notes
The 2007 Treatment Guidelines section will contain the 2007 published guidelines. To view Guidelines from previous years, view year 2006 Treatment Guidelines and 2005 InfoMedlinks (Articles section) or our Monthly Online Newsletter (under the Guidelines section).
Back Pain - Sciatica
Daily Treatment Report
Cognitive Therapy-CBT-Psychotherapy
Meta-analysis of psychological interventions for chronic low back pain. (Health Psychol. 2007) "The results demonstrated positive effects of psychological interventions for CLBP. The rigor of the methods used, as well as the results that reflect mild to moderate heterogeneity and minimal publication bias, suggest confidence in the conclusions of this review."
Device Therapy
Drug Side-Effects and Interactions
Drugs
Complications of spinal infusion therapies (Techniques in Regional Anesthesia and Pain Management 2007)
A Double-blind, Placebo-controlled, Dose-Response Pilot Study Evaluating Intradiscal Etanercept in Patients with Chronic Discogenic Low Back Pain or Lumbosacral Radiculopathy. (Anesthesiology. 2007) "CONCLUSIONS:: Although no serious side effects were observed in this small study, a single low dose of intradiscal etanercept does not seem to be an effective treatment for chronic radicular or discogenic low back pain."
Exercise
The impact of aerobic fitness on functioning in chronic back pain. (Eur Spine J. 2007)
The efficacy of exercise as an intervention to treat recurrent nonspecific low back pain in adolescents. (Pediatr Exerc Sci. 2007)
Effectiveness of a home exercise programme in low back pain: a randomized five-year follow-up study. (Physiother Res Int. 2007) "Conclusions. The present randomized study indicates that supervised, controlled home exercises lead to reduced low back pain, and that positive effects were preserved over five years."
Summaries for patients. Physiotherapist-directed exercise, advice, or both for low back pain. (Ann Intern Med. 2007) "Patients who received both exercise and advice had the most benefit at 6 weeks. At 12 months, most of the benefits were no longer present."
Physiotherapist-Directed Exercise, Advice, or Both for Subacute Low Back Pain: A Randomized Trial (Ann Intern Med 2007) "Conclusions: In participants with subacute low back pain, physiotherapist-directed exercise and advice were each slightly more effective than placebo at 6 weeks. The effect was greatest when the interventions were combined. At 12 months, the only effect that persisted was a small effect on participant-reported function."
The role of the back rx exercise program in diskogenic low back pain: a prospective randomized trial. (Arch Phys Med Rehabil. 2007) "CONCLUSIONS: Back Rx exercises, combined with use of a lumbar cryobrace and oral medications, yielded superior therapeutic results than with use of medications and cryobrace alone. Also significant was the reduced rate of recurrence in these patients."
Improving Low Back Pain With Exercise
General Information
Multidisciplinary Treatment May Benefit Patients With Chronic Low Back Pain “Multidisciplinary therapy for patients with CLBP can be recommended for patients in all stages of chronicity.“
Sciatica from disk herniation: Medical treatment or surgery (Joint Bone Spine 2007) “Disk-related sciatica is a common disorder that resolves without surgery in 95% of patients within 1 to 12 months. Several treatment strategies designed to hasten recovery, enable a return to previous social and occupational activities, and prevent chronicization have been evaluated. … Bed rest, systemic glucocorticoid therapy, spinal manipulation, bracing, spinal traction, and physical therapy have no proven effects on the outcome of sciatica.”
Expert opinion and controversies in musculoskeletal and sports medicine: core stabilization as a treatment for low back pain. (Arch Phys Med Rehabil. 2007)
Nonoperative Treatment of Symptomatic Spondylolysis. (J Spinal Disord Tech. 2007)
Sciatica from disk herniation: Medical treatment or surgery? (Joint Bone Spine. 2007)
Lumbar Supports to Prevent Recurrent Low Back Pain among Home Care Workers (Annals 2007)
A new episode of low back pain: Who relies on bed rest? (Eur J Pain. 2007) "Patients with prolonged bed rest in an early phase of pain were still more disabled after one year (p<0.01). Based on these results we conclude that prolonged bed rest in the early phase of pain is associated with a higher long term disability level. In preventing low back disability, GP screening for catastrophizing and fear of injury in LBP patients who had prolonged bed rest merits consideration."
The effects of a back rehabilitation programme for patients with chronic low back pain. (J Eval Clin Pract. 2007)
Effect sizes of non-surgical treatments of non-specific low-back pain. (Eur Spine J. 2007) "As a conclusion, the effect of treatments for LBP is only small to moderate. Therefore, there is a dire need for developing more effective interventions."
Active exercise, education, and cognitive behavioral therapy for persistent disabling low back pain: a randomized controlled trial. (Spine. 2007) "CONCLUSIONS: This intervention program produces only modest effects in reducing LBP and disability over a 1-year period. The observation that patient preference for treatment influences outcome warrants further investigation."
Surgery versus Prolonged Conservative Treatment for Sciatica (NEJM 2007) "Conclusions The 1-year outcomes were similar for patients assigned to early surgery and those assigned to conservative treatment with eventual surgery if needed, but the rates of pain relief and of perceived recovery were faster for those assigned to early surgery."
Evaluation and treatment of acute low back pain. (Am Fam Physician. 2007)
[Discogenic Low Back Pain. Minimaly invasive interventional therapies.] (Anasthesiol Intensivmed Notfallmed Schmerzther. 2007)
Magnetic Resonance Imaging Findings as Predictors of Clinical Outcome in Patients With Sciatica Receiving Active Conservative Treatment (Journal of Manipulative and Physiological Therapeutics 2007)
Clinical inquiries: Treatment of acute sciatica.
Treatment of acute sciatica. (Am Fam Physician. 2007) "Acute sciatica is lower back pain with radiculopathy below the knee and symptoms lasting up to six weeks. … caused by a variety of conditions: disk herniation, lumbar spinal stenosis, facet joint osteoarthritis or other arthropathies, spinal cord infection or tumor, or spondylolisthesis. … Clinical Commentary: An efficient clinical history and thorough physical examination of a patient with suspected sciatica is needed to rule out urgent conditions like cauda equina syndrome, infection, or cancer, and to determine the need for diagnostic tests. After the acute episode, emphasis is placed on activity, back exercises, behavioral techniques, ergonomics education, and close clinical monitoring. Educating patients on self-care and establishing reasonable expectations usually increase patient compliance with therapy and improve satisfaction."
Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction. (nn Intern Med. 2007) "CONCLUSIONS: Opioids are commonly prescribed for chronic back pain and may be efficacious for short-term pain relief. Long-term efficacy (> or =16 weeks) is unclear. Substance use disorders are common in patients taking opioids for back pain, and aberrant medication-taking behaviors occur in up to 24% of cases."
Fentanyl buccal tablet (FBT) for relief of breakthrough pain in opioid-treated patients with chronic low back pain: a randomized, placebo-controlled study. (Curr Med Res Opin. 2007) "CONCLUSIONS: FBT was efficacious and well tolerated in the treatment of BTP in opioid-treated patients with chronic low back pain."
Guidelines
Guidelines Issued for Management of Low Back Pain
Medications for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline (Ann Intern Med. 2007) "Conclusions: Medications with good evidence of short-term effectiveness for low back pain are NSAIDs, acetaminophen, skeletal muscle relaxants (for acute low back pain), and tricyclic antidepressants (for chronic low back pain). Evidence is insufficient to identify one medication as offering a clear overall net advantage because of complex tradeoffs between benefits and harms. Individual patients are likely to differ in how they weigh potential benefits, harms, and costs of various medications."
Guidelines Issued for Management of Low Back Pain "In the United States, several studies suggest that approximately 25% of adults report having had low back pain in the past 3 months, whereas 7.6% report at least 1 episode of severe acute low back pain within the previous year. Clinical evidence suggests that regardless of treatment, most low back pain improves within 1 month. Available treatment options range from watchful waiting to conservative treatment with pharmacologic and nonpharmacologic modalities to invasive procedures such as spinal surgery."
NGC - Low back - lumbar & thoracic (acute & chronic). (2007)
The challenge of using the low back pain guidelines: a qualitative research. (J Eval Clin Pract. 2007)
Internet Sites
Treatment Information
Drug-Food-Supplement Information
DrugDigest (drug interactions)
FDA - Drug Interactions: What You Should Know
NIH - Botanical Dietary Supplements: Background Information
NIH - Drug, Supplements, and Herbal Information
NIH - Herbal Supplements: Consider Safety, Too
NIH - Vitamin and Mineral Supplement Fact Sheets
Nutrition
Other
Other Treatments
Insoles for prevention and treatment of back pain. (Cochrane Database Syst Rev. 2007)
Treatment of chronic low back pain with botulinum neurotoxins. (Curr Pain Headache Rep. 2007)
German Acupuncture Trials (GERAC) for Chronic Low Back Pain (Arch Intern Med. 2007) "Conclusions Low back pain improved after acupuncture treatment for at least 6 months. Effectiveness of acupuncture, either verum or sham, was almost twice that of conventional therapy."
Treatment of chronic low back pain with botulinum neurotoxins. (Curr Pain Headache Rep. 2007)
Naturopathic care for chronic low back pain: a randomized trial. (PLoS ONE. 2007)
Study: Acupuncture Works for Back Pain "Fake acupuncture works nearly as well as the real thing for low back pain, and either kind performs much better than usual care, German researchers have found. Almost half the patients treated with acupuncture needles felt relief that lasted months. In contrast, only about a quarter of the patients receiving medications and other Western medical treatments felt better. Even fake acupuncture worked better than conventional care, leading researchers to wonder whether pain relief came from the body's reactions to any thin needle pricks or, possibly, the placebo effect."
Changes in pain and disability secondary to shoe lift intervention in subjects with limb length inequality and chronic low back pain: a preliminary report. (J Orthop Sports Phys Ther. 2007) " CONCLUSION: Shoe lifts may reduce LBP and improve function for patients who have chronic LBP and an LLI. Randomized controlled trials are needed to assess the efficacy of this intervention."
Prolotherapy injections for chronic low-back pain. (Cochrane Database Syst Rev. 2007)
Traction for low-back pain with or without sciatica. (Cochrane Database Syst Rev. 2007) "AUTHORS' CONCLUSIONS: Implications for practice The results of the available studies involving mixed groups of acute, sub-acute and chronic patients with LBP with and without sciatica were quite consistent, indicating that continuous or intermittent traction as a single treatment for LBP is not likely effective for this group. Traction for patients with sciatica cannot be judged effective at present either, due to inconsistent results and methodological problems in most studies. We conclude that traction as a single treatment for LBP is probably not effective. Implications for research Any future research on traction for patients with LBP should distinguish between symptom pattern and duration, and should be carried out according to the highest methodological standards."
Assessment: Use of epidural steroid injections to treat radicular lumbosacral pain (NEUROLOGY 2007) " … in general, epidural steroid injection for radicular lumbosacral pain does not impact average impairment of function, need for surgery, or provide long-term pain relief beyond 3 months. Their routine use for these indications is not recommended (Level B, Class I-III evidence); 3) there is insufficient evidence to make any recommendation for the use of epidural steroid injections to treat radicular cervical pain (Level U)."
Experimental
Radiotherapy
Supplements-Vitamins-CAM
Herbal medicine for low back pain: a Cochrane review. (Spine. 2007) "CONCLUSIONS: Harpagophytum procumbens, Salix alba, and Capsicum frutescens seem to reduce pain more than placebo. Additional trials testing these herbal medicines against standard treatments will clarify their equivalence in terms of efficacy. The quality of reporting in these trials was generally poor; thus, trialists should refer to the CONSORT statement in reporting clinical trials of herbal medicines."
Surgery
[Findings in 67 patients with recurrent or persistent symptoms after implantation of a disc prosthesis for low back pain] (Ned Tijdschr Geneeskd. 2007)
Study Shows Surgery Is More Effective Than Other Treatments for Common Back Problem
Surgery versus Prolonged Conservative Treatment for Sciatica (NEJM 2007) "Conclusions The 1-year outcomes were similar for patients assigned to early surgery and those assigned to conservative treatment with eventual surgery if needed, but the rates of pain relief and of perceived recovery were faster for those assigned to early surgery."
Surgical interventions for lumbar disc prolapse. (Cochrane Database Syst Rev. 2007) " AUTHORS' CONCLUSIONS: Surgical discectomy for carefully selected patients with sciatica due to lumbar disc prolapse provides faster relief from the acute attack than conservative management, although any positive or negative effects on the lifetime natural history of the underlying disc disease are still unclear. Microdiscectomy gives broadly comparable results to open discectomy. The evidence on other minimally invasive techniques remains unclear (with the exception of chemonucleolysis using chymopapain, which is no longer widely available)."
Surgical or nonoperative treatment for lumbar spinal stenosis?: a randomized controlled trial. (Spine. 2007) "CONCLUSIONS: Although patients improved over the 2-year follow-up regardless of initial treatment, those undergoing decompressive surgery reported greater improvement regarding leg pain, back pain, and overall disability. The relative benefit of initial surgical treatment diminished over time, but outcomes of surgery remained favorable at 2 years. Longer follow-up is needed to determine if these differences persist."
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