Limits...
Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis.

Pinto RZ, Maher CG, Ferreira ML, Ferreira PH, Hancock M, Oliveira VC, McLachlan AJ, Koes B - BMJ (2012)

Bottom Line: Data were pooled with a random effects model, and the GRADE approach was used in summary conclusions.Twenty three published reports met the inclusion criteria.Most of the pooled estimates did not favour the active treatment over placebo.

View Article: PubMed Central - PubMed

Affiliation: George Institute for Global Health, University of Sydney, PO Box M201, Camperdown, Sydney, NSW 2050, Australia. rafaelzambelli@gmail.com

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.

Show MeSH

Related in: MedlinePlus

Fig 1 Selection process of trials examining pain relief in patients with sciatica
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC3278391&req=5

fig1: Fig 1 Selection process of trials examining pain relief in patients with sciatica

Mentions: Figure 1 outlines the flow of trials through the review. The initial electronic database search identified 2460 potential studies of interest. After screening citations by title and abstract, we considered 197 potentially eligible articles for inclusion and retrieved full articles. We included 23 published reports2122232425262728293031323334353637383940414243 (reporting 24 different clinical trials, as one28 reported on two trials). Three trials reported in previous systematic reviews12444546 were not included in this review because of unclear randomisation.474849


Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis.

Pinto RZ, Maher CG, Ferreira ML, Ferreira PH, Hancock M, Oliveira VC, McLachlan AJ, Koes B - BMJ (2012)

Fig 1 Selection process of trials examining pain relief in patients with sciatica
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3278391&req=5

fig1: Fig 1 Selection process of trials examining pain relief in patients with sciatica
Mentions: Figure 1 outlines the flow of trials through the review. The initial electronic database search identified 2460 potential studies of interest. After screening citations by title and abstract, we considered 197 potentially eligible articles for inclusion and retrieved full articles. We included 23 published reports2122232425262728293031323334353637383940414243 (reporting 24 different clinical trials, as one28 reported on two trials). Three trials reported in previous systematic reviews12444546 were not included in this review because of unclear randomisation.474849

Bottom Line: Data were pooled with a random effects model, and the GRADE approach was used in summary conclusions.Twenty three published reports met the inclusion criteria.Most of the pooled estimates did not favour the active treatment over placebo.

View Article: PubMed Central - PubMed

Affiliation: George Institute for Global Health, University of Sydney, PO Box M201, Camperdown, Sydney, NSW 2050, Australia. rafaelzambelli@gmail.com

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.

Show MeSH
Related in: MedlinePlus