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Evidence review for pharmacological management of sciatica: Low back pain and sciatica in over 16s: assessment and management: Evidence review AäEvidence review for pharmacological management of sciatica: Low back pain and sciatica in over 16s: assessment and management: Evidence review A-/-NICE Evidence Reviews Collection 2020[Sep]; ä (ä): äSciatica is a general term for pain in the leg as a result of nerve compression or irritation in the lumbar spine. This is sometimes referred to as radicular pain. Many people with low back pain have referred pain in the leg, without nerve compression. The commonest cause is impingement or inflammation of the lumbosacral nerve roots and is frequently associated with herniation of a lumbar intervertebral disc. In older people, additional anatomical changes may be important. Anatomical structures and abnormal movement in the back can also cause pain to be felt or 'referred' to the leg. It can be difficult to differentiate referred pain from sciatica, and the two may co-exist. The pharmacological management of back pain, including referred pain, was included in 'Low back pain and sciatica in over 16s: assessment and management' (NG59). People with sciatica typically have severe pain at onset and a slower and less complete recovery than people with back pain without sciatica. A review of pharmacological interventions for sciatica is important because people with sciatica commonly present in primary care. Drugs for neuropathic pain are frequently prescribed for sciatica in addition to opioids and other analgesics. There is high variability of prescribing volumes between CCGs and different population groups. A significant proportion of people continue taking medication for sciatica in the longer term. When NG59 was first published in 2016, the guideline cross-referenced 'Neuropathic pain in adults: pharmacological management in non-specialist settings' (CG173) for the pharmacological management of sciatica. A MHRA drug safety update in April 2019 advised that gabapentin and pregabalin were reclassified as controlled drugs. This triggered an exceptional surveillance review for NG59. The frequent presentation for relief of leg pain associated with back pain and sciatica in primary care, the unknown efficacy of drugs for neuropathic pain in sciatica, and the reclassification of some drugs used to treat sciatica coupled with the variation in prescribing patterns warrants a fresh review of the pharmacological management of sciatica.ä |
