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Treating sciatica in the face of poor evidence

BMJ 2012; 344 doi: (Published 13 February 2012) Cite this as: BMJ 2012;344:e487
  1. Roger Chou, associate professor of medicine
  1. 1Department of Medicine and Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR 97225, USA
  1. chour{at}

It may be necessary to extrapolate from evidence on treatment of other neuropathic pain syndromes

The term “sciatica” is often applied to any presentation of low back and leg pain, although lumbosacral radiculopathy is a more specific term for the condition experienced by patients with low back pain who have impingement of lumbosacral nerve roots as they emerge from the spinal canal. This results in pain and sensory deficits in a dermatomal distribution and sometimes motor weakness in the corresponding myotomal distribution. Because the most commonly affected nerve roots are L4/L5 and L5/S1, pain typically radiates below the knee, and leg pain (elicited by performing the straight leg raise test) may be more pronounced than back pain. The most common cause of lumbosacral radiculopathy is intervertebral disc herniation, which occurs in about 3% of patients with acute low back pain.1 Other causes include spondylolisthesis and foraminal stenosis owing to degenerative osteophytes.

The linked systematic review and meta-analysis by Pinto and colleagues (doi:10.1136/bmj.e497) finds little direct evidence …

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