Sciatic Nerve Pain

New research suggests that surgery for sciatic nerve pain may not lead to better outcomes when compared to conservative care. However, the patients that had surgery had faster relief from pain which has important implications if you are a breadwinner and you need to get back to work.

The Study Details

The authors wanted to find out if having lumbar disc surgery is better than simple non surgical conservative care for people with sciatic nerve pain from a disc bulge. This surgery is called 'microdiscectomy' and is commonplace in western society.

The study looked at 283 patients with between 6-12 weeks of sciatica and randomly put 50% of them in for surgery, the other 50% were taken care of by their doctors. This care included reassurance that the symptoms would eventually settle, lower back pain relief medication and advice to remain active. If the patient had a lot of fear avoidance then a physiotherapist offered guidance and help too.

Its worth noting that 62 of the patients who were having the non-surgical treatment ended up having surgery in the end because of pain or worsening neurological signs.

Also of interest is the fact that in 6% of surgically treated patients the sciatic nerve pain came back which meant they had to have more surgery.

Results

There was a big difference in pain scores between the groups in the first 6 months – the surgically treated patients felt better. However, these differences disappeared after that and both groups ended up the same.

In fact by the end of the first year  95% of patients in both groups had a satisfactory recovery, and this was the same after two years.

What does this mean to you?

  • If you have uncomplicated sciatic nerve pain there is a good chance that the symptoms will go away by themselves within 6 months to a year.


  • If you have surgery it is likely that you will get faster pain relief.


  • There is a chance that the symptoms will come back even if you have surgery.


  • Leaving it all alone may not work for everyone, a percentage of those who were supposed to have conservative care ended up having surgery as their pain was too bad or because they had worsening neurological changes.

There are of course other things to think about.

  • A quick reduction in pain may get you back to work/ back to normal activities faster which has to be good. Not everyone can afford to wait 6 months if they can't work.


  • A decision about surgery needs to be carefully considered, any surgery is risky and can have complications and if you don’t need back surgery it's definitely better not to have it!


  • Having surgery should not be automatic and the decision about whether you need surgery or not needs to be made with your consultant, as there are certain symptoms which will need earlier treatment such as these signs of serious back problems.

References

Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial -- Peul et al., 10.1136/bmj.a143 -- BMJ. Available at: http://www.bmj.com/cgi/reprint/bmj.a143v1 [Accessed June 6, 2008].

Other Online Resources

Check out this spine health page which talks about surgery.

Back Pain News and Research

Sciatica Causes

More Sciatica Symptoms- Severe Lower Back Problems

Sciatica Home Treatment

Sciatica and Physical Therapy

Sciatica Exercises

Lower Back Pain Toolkit Home Page

29-Jul-2017

 

 

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