Sciatica (cont.)
How is sciatica treated?
Bed rest has been traditionally advocated for the treatment of sciatica. But how useful is it?
To study the effectiveness of bed rest in patients with sciatica
of sufficient severity to justify treatment with bed rest for two
weeks, a research team in the Netherlands led by Dr. Patrick Vroomen randomly assigned 183 such patients to bed rest or,
alternatively, to watchful waiting for this period.
To gauge the outcome, both primary and secondary measures were
examined. The primary outcome measures were the global assessments of improvement after
two and 12
weeks by the doctor and the patient. The secondary outcome measures
were changes in functional status and in pain scores, absenteeism from work, and the need for surgical intervention. Neither the doctors who assessed the
outcomes nor those involved in data entry and analysis were aware of the patients' treatment assignments.
The results, reported in the New England Journal of
Medicine, showed that after two weeks, 64 of the 92 (70%) patients in the bed-rest group reported improvement, as compared with 59 of the
91 (65%) of the patients in the control (watchful-waiting) group. After 12 weeks, 87% of the patients in both groups reported improvement. The results of assessments
of the intensity of pain, the aggravation of symptoms, and
functional status revealed no significant differences between the two
groups. The extent of absenteeism from work and rates of surgical
intervention were similar in the two groups.
The researchers concluded that "among patients with
symptoms and signs of a lumbosacral radicular syndrome, bed rest is not a more effective therapy than watchful waiting." Sometimes, conventional wisdom is not as wise as research!
Other treatments for sciatica include addressing the underlying cause, medications to relieve pain and inflammation and relax muscles, and physical therapy. Surgical procedures can sometimes be required for persisting sciatica that is
caused by nerve compression at
the lower spine.
- Sciatica is a nerve pain from irritation of the
sciatic nerve.
- The sciatic nerve is the largest nerve in the body.
- Sciatica pain is typically felt from the low back to
behind the thigh and radiating down below the knee.
- Treatments for sciatica depend on the underlying cause and the severity of
the pain.
Reference:
Patrick, C.A.J. Vroomen, Marc C.T.F.M. de Krom, Jan T.
Wilmink, Arnold D.M. Kester, J. Andre Knottnerus. Lack of
Effectiveness of Bed Rest for Sciatica. N Engl J Med 1999; 340:418-
23.
Last Editorial Review: 9/2/2009
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