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Fakih O, Verhoeven F, Prati C, Wendling D. Gunshot acquired sciatica. Joint Bone Spine 2024; 91:105709. [PMID: 38401623 DOI: 10.1016/j.jbspin.2024.105709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/25/2024] [Accepted: 02/14/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Olivier Fakih
- Service de rhumatologie, CHU de Besançon, 25000 Besançon, France.
| | - Frank Verhoeven
- Service de rhumatologie, CHU de Besançon, 25000 Besançon, France
| | - Clément Prati
- Service de rhumatologie, CHU de Besançon, 25000 Besançon, France
| | - Daniel Wendling
- Service de rhumatologie, CHU de Besançon, 25000 Besançon, France
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Si LG, A RN, Mu R, Wu QZ, Ga LT, Bai L, A RGT, Bao LD, A GL. Efficacy evaluation of Mongolian medical warm acupuncture for sciatica caused by lumbar disc herniation: a randomized, controlled, single-blind clinical trial. Eur Rev Med Pharmacol Sci 2024; 28:2224-2236. [PMID: 38567586 DOI: 10.26355/eurrev_202403_35727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE This study aimed to evaluate the short-term and long-term efficacy of Mongolian medical warm acupuncture for sciatica caused by lumbar disc herniation (LDH). PATIENTS AND METHODS The patients diagnosed with sciatica caused by LDH were randomly divided into the warm acupuncture of the Mongolian medicine group (n = 42, warm acupuncture treatment), the sham acupuncture group (n = 38, sham acupuncture using blunt-tipped needles) and the conventional drug group (n = 40, ibuprofen sustained release capsule). All patients were treated for 4 weeks and followed up for 8 weeks. The visual analog scale for leg pain (VAS-LP), Mongolian medicine indicators (efficacy indicators), VAS for waist pain (VAS-WP) and the Mos 36-item short form health survey (SF-36) score were analyzed at baseline, after two-week treatment, after four-week treatment, at four-week follow-up and at eight-week follow-up. RESULTS Warm acupuncture treatment significantly decreased the VAS-LP and VAS-WP scores of patients at treatment and follow-up (p < 0.05), and pain was improved compared to the conventional drug group and sham acupuncture group. The total effective rate was markedly higher in the warm acupuncture of the Mongolian medicine group compared with the conventional drug group at 8-week follow-up (p < 0.05), but sham acupuncture treatment resulted in no evident improvement in the Mongolian medicine indicators. Additionally, at treatment and follow-up, warm acupuncture of the Mongolian medicine group showed a significant increase in the physical function, physical role, body pain, and emotional and mental health role scores of the SF-36 survey compared with the sham acupuncture groups. CONCLUSIONS Mongolian medical warm acupuncture effectively relieves leg and waist pain and improves the total therapeutic effect and the quality of daily life for patients with sciatica caused by LDH, with significant long-term efficacy. Our study provides a basis for warm acupuncture in the treatment of sciatica caused by LDH. Chinese Clinical Trial Registry ID: ChiCTR- INR-15007413.
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Affiliation(s)
- L-G Si
- Mongolian Traditional Therapy Teaching and Research Section, Mongolian Medicine School, Inner Mongolian Medical University, Hohhot, P. R. China.
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Zhang GY, Incze MA. I Am Worried I Have Sciatica-What Do I Need to Know? JAMA Intern Med 2024; 184:122. [PMID: 37955926 DOI: 10.1001/jamainternmed.2023.5990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
This JAMA Internal Medicine Patient Page reviews sciatica, its symptoms, and treatment options for those who have it.
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Affiliation(s)
- Grace Y Zhang
- Division of General Internal Medicine, University of California, San Francisco
- Editorial Fellow, JAMA Internal Medicine
| | - Michael A Incze
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah, Salt Lake City
- Section Editor, JAMA Internal Medicine
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Li C, Qi X, Wang F, Wang J. Clinical Efficacy of Acupuncture with Canggui Tanxue Technique on Huantiao Point for Treating Sciatica Caused by Lumbar Disc Herniation. Altern Ther Health Med 2023; 29:376-381. [PMID: 37535908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Objective The present study aimed to assess the clinical efficacy of acupuncture with the Canggui Tanxue Technique on the Huantiao point for treating sciatica caused by lumbar disc herniation. Methods This randomized controlled trial evaluated outpatient and inpatient data of patients from the Department of Acupuncture and Encephalopathy at Yancheng City Hospital of Traditional Chinese Medicine, Nanjing University of Traditional Chinese Medicine, between March 2020 and October 2022. A total of 100 eligible cases were recruited. Patients were randomly assigned using a random number table method at a ratio of 1:1 to receive either routine acupuncture technique on the Huantiao point (control group) or Canggui Tanxue Technique on the Huantiao point (Canggui Tanxue group), with 50 cases in each group. Outcome measures included post-treatment pain and clinical efficacy. Results Canggui Tanxue Technique demonstrated significant pain reduction and improved functional restoration compared to the routine technique, as evidenced by significantly lower scores on the Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) scores, and Roland-Morris Disability Questionnaire (RDQ) scores (P < .05). Patients receiving acupuncture with Canggui Tanxue Technique exhibited significantly higher clinical efficacy compared to those receiving the routine technique (P < .05). Conclusion Acupuncture with Canggui Tanxue Technique on the Huantiao point provides superior pain reduction and functional restoration for patients with sciatica caused by lumbar disc herniation compared to routine techniques. This approach offers high safety, potent efficiency, and better operability.
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Liu C, Ferreira GE, Abdel Shaheed C, Chen Q, Harris IA, Bailey CS, Peul WC, Koes B, Lin CWC. Surgical versus non-surgical treatment for sciatica: systematic review and meta-analysis of randomised controlled trials. BMJ 2023; 381:e070730. [PMID: 37076169 PMCID: PMC10498296 DOI: 10.1136/bmj-2022-070730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To investigate the effectiveness and safety of surgery compared with non-surgical treatment for sciatica. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organisation International Clinical Trials Registry Platform from database inception to June 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials comparing any surgical treatment with non-surgical treatment, epidural steroid injections, or placebo or sham surgery, in people with sciatica of any duration due to lumbar disc herniation (diagnosed by radiological imaging). DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data. Leg pain and disability were the primary outcomes. Adverse events, back pain, quality of life, and satisfaction with treatment were the secondary outcomes. Pain and disability scores were converted to a scale of 0 (no pain or disability) to 100 (worst pain or disability). Data were pooled using a random effects model. Risk of bias was assessed with the Cochrane Collaboration's tool and certainty of evidence with the grading of recommendations assessment, development, and evaluation (GRADE) framework. Follow-up times were into immediate term (≤six weeks), short term (>six weeks and ≤three months), medium term (>three and <12 months), and long term (at 12 months). RESULTS 24 trials were included, half of these investigated the effectiveness of discectomy compared with non-surgical treatment or epidural steroid injections (1711 participants). Very low to low certainty evidence showed that discectomy, compared with non-surgical treatment, reduced leg pain: the effect size was moderate at immediate term (mean difference -12.1 (95% confidence interval -23.6 to -0.5)) and short term (-11.7 (-18.6 to -4.7)), and small at medium term (-6.5 (-11.0 to -2.1)). Negligible effects were noted at long term (-2.3 (-4.5 to -0.2)). For disability, small, negligible, or no effects were found. A similar effect on leg pain was found when comparing discectomy with epidural steroid injections. For disability, a moderate effect was found at short term, but no effect was observed at medium and long term. The risk of any adverse events was similar between discectomy and non-surgical treatment (risk ratio 1.34 (95% confidence interval 0.91 to 1.98)). CONCLUSION Very low to low certainty evidence suggests that discectomy was superior to non-surgical treatment or epidural steroid injections in reducing leg pain and disability in people with sciatica with a surgical indication, but the benefits declined over time. Discectomy might be an option for people with sciatica who feel that the rapid relief offered by discectomy outweighs the risks and costs associated with surgery. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021269997.
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Affiliation(s)
- Chang Liu
- Sydney Musculoskeletal Health, University of Sydney, Sydney, NSW, Australia
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Giovanni E Ferreira
- Sydney Musculoskeletal Health, University of Sydney, Sydney, NSW, Australia
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Christina Abdel Shaheed
- Sydney Musculoskeletal Health, University of Sydney, Sydney, NSW, Australia
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Qiuzhe Chen
- Sydney Musculoskeletal Health, University of Sydney, Sydney, NSW, Australia
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Christopher S Bailey
- Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| | - Wilco C Peul
- Neurosurgical Center Holland, Leiden University Medical Center and Haaglanden MC and Haga Teaching Hospital, The Hague-Leiden, Netherlands
| | - Bart Koes
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Netherlands
| | - Chung-Wei Christine Lin
- Sydney Musculoskeletal Health, University of Sydney, Sydney, NSW, Australia
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
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Guo L, Li L, Li X, Li L, Zhang L, Zhang H. Efficacy and safety of warm acupuncture combined with Western medicine for sciatica: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e32543. [PMID: 36607877 PMCID: PMC9829287 DOI: 10.1097/md.0000000000032543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND There are more and more clinical studies on the efficacy of warm acupuncture in treating sciatica, but the systematic review of the efficacy of warm acupuncture is still lacking. The objective of this study was to evaluate the efficacy and safety of warm acupuncture combined with conventional Western medicine in the treatment of sciatica. METHODS The review was registered in the PROSPERO database (CRD42022379486) and was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The following databases will be used to search the existing literature (from inception to January 2023): Web of Science, Embase, Cochrane Library, PubMed, Cumulative Index to Nursing and Allied Health Literature, Wanfang, Allied and Complementary Medicine Database, China Knowledge Network, and SPORT-Discus. Included studies are considered eligible if they met the population, intervention, comparator, outcomes, and study design criteria as follows: Population: patients with newly diagnosed sciatica; Intervention: warm acupuncture combined with conventional Western medicine; Comparator: Western medicine alone; Outcomes: total response rate, pain score and pain threshold, adverse events and recurrence rate. Study design: randomized controlled trials or non-randomized cohort studies. Review Manager (RevMan) V.5.3 will be used to perform statistical analyses and to generate forest plots. RESULTS The review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings.
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Affiliation(s)
- Lingling Guo
- Osteopathy Department of Integrated Traditional Chinese and Western Medicine, Zibo Central Hospital, Zibo, Shandong, China
| | - Liang Li
- Department of Chinese Medicine, Zibo Central Hospital, Zibo, Shandong, China
| | - Xiuli Li
- Department of Plastic and Cosmetic Surgery, Zibo Central Hospital, Zibo, Shandong, China
| | - Linghan Li
- Osteopathy Department of Integrated Traditional Chinese and Western Medicine, Zibo Central Hospital, Zibo, Shandong, China
| | - Lijin Zhang
- Osteopathy Department of Integrated Traditional Chinese and Western Medicine, Zibo Central Hospital, Zibo, Shandong, China
| | - Haixia Zhang
- Department of Internet, Zibo Central Hospital, Zibo, Shandong, China
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Furlong B, Etchegary H, Aubrey-Bassler K, Swab M, Pike A, Hall A. Patient education materials for non-specific low back pain and sciatica: A systematic review and meta-analysis. PLoS One 2022; 17:e0274527. [PMID: 36223377 PMCID: PMC9555681 DOI: 10.1371/journal.pone.0274527] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/28/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Guidelines recommend patient education materials (PEMs) for low back pain (LBP), but no systematic review has assessed PEMs on their own. We investigated the effectiveness of PEMs on process, clinical, and health system outcomes for LBP and sciatica. Methods Systematic searches were performed in MEDLINE, EMBASE, CINAHL, PsycINFO, SPORTDiscus, trial registries and grey literature through OpenGrey. We included randomized controlled trials of PEMs for LBP. Data extraction, risk of bias, and quality of evidence gradings were performed independently by two reviewers. Standardized mean differences or risk ratios and 95% confidence intervals were calculated, and effect sizes pooled using random-effects models. Analyses of acute/subacute LBP were performed separately from chronic LBP at immediate, short, medium, and long-term (6, 12, 24, and 52 weeks, respectively). Results 27 studies were identified. Compared to usual care for chronic LBP, we found moderate to low-quality evidence that PEMs improved pain intensity at immediate (SMD = -0.16 [95% CI: -0.29, -0.03]), short (SMD = -0.44 [95% CI: -0.88, 0.00]), medium (SMD = -0.53 [95% CI: -1.01, -0.05]), and long-term (SMD = -0.21 [95% CI: -0.41, -0.01]), medium-term disability (SMD = -0.32 [95% CI: -0.61, -0.03]), quality of life at short (SMD = -0.17 [95% CI: -0.30, -0.04]) and medium-term (SMD = -0.23 [95% CI: -0.41, -0.04]) and very low-quality evidence that PEMs improved global improvement ratings at immediate (SMD = -0.40 [95% CI: -0.58, -0.21]), short (SMD = -0.42 [95% CI: -0.60, -0.24]), medium (SMD = -0.46 [95% CI: -0.65, -0.28]), and long-term (SMD = -0.43 [95% CI: -0.61, -0.24]). We found very low-quality evidence that PEMs improved pain self-efficacy at immediate (SMD = -0.21 [95% CI: -0.39, -0.03]), short (SMD = -0.25 [95% CI: -0.43, -0.06]), medium (SMD = -0.23 [95% CI: -0.41, -0.05]), and long-term (SMD = -0.32 [95% CI: -0.50, -0.13]), and reduced medium-term fear-avoidance beliefs (SMD = -0.24 [95% CI: -0.43, -0.06]) and long-term stress (SMD = -0.21 [95% CI: -0.39, -0.03]). Compared to usual care for acute LBP, we found high to moderate-quality evidence that PEMs improved short-term pain intensity (SMD = -0.24 [95% CI: -0.42, -0.06]) and immediate-term quality of life (SMD = -0.24 [95% CI: -0.42, -0.07]). We found low to very low-quality evidence that PEMs increased knowledge at immediate (SMD = -0.51 [95% CI: -0.72, -0.31]), short (SMD = -0.48 [95% CI: -0.90, -0.05]), and long-term (RR = 1.28 [95% CI: 1.10, 1.49]) and pain self-efficacy at short (SMD = -0.78 [95% CI: -0.98, -0.58]) and long-term (SMD = -0.32 [95% CI: -0.52, -0.12]). We found moderate to very low-quality evidence that PEMs reduced short-term days off work (SMD = -0.35 [95% CI: -0.63, -0.08]), long-term imaging referrals (RR = 0.60 [95% CI: 0.41, 0.89]), and long-term physician visits (SMD = -0.16 [95% CI: -0.26, -0.05]). Compared to other interventions (e.g., yoga, Pilates), PEMs had no effect or were less effective for acute/subacute and chronic LBP. Conclusions There was a high degree of variability across outcomes and time points, but providing PEMs appears favorable to usual care as we observed many small, positive patient and system impacts for acute/subacute and chronic LBP. PEMs were generally less effective than other interventions; however, no cost effectiveness analyses were performed to weigh the relative benefits of these interventions to the likely less costly PEMs.
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Affiliation(s)
- Bradley Furlong
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Holly Etchegary
- Clinical Epidemiology, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Michelle Swab
- Health Sciences Library, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Andrea Pike
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Amanda Hall
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
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Yu FT, Liu CZ, Ni GX, Cai GW, Liu ZS, Zhou XQ, Ma CY, Meng XL, Tu JF, Li HW, Yang JW, Yan SY, Fu HY, Xu WT, Li J, Xiang HC, Sun TH, Zhang B, Li MH, Wan WJ, He C, Ji XL, Zhu W, Shi GX, Wang LQ. Acupuncture for chronic sciatica: protocol for a multicenter randomised controlled trial. BMJ Open 2022; 12:e054566. [PMID: 35580967 PMCID: PMC9114849 DOI: 10.1136/bmjopen-2021-054566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Chronic Sciatica is a disabling condition causing considerable medical, social and financial implications. Currently, there is no recognised long-term effective treatment to alleviate sciatica. Acupuncture has been widely used for treating chronic pains with persistent analgesic effects. We aim to evaluate the efficacy and safety of acupuncture for chronic sciatica with follow-up in 52 weeks. METHODS AND ANALYSIS This is a multicenter randomised sham-controlled trial. A total of 216 patients with chronic sciatica will be enrolled and randomly assigned to the acupuncture or sham acupuncture group. There will be 10 treatment sessions applied in 4 weeks with frequency decreased over time. Patients will complete follow-ups during 52 weeks. The primary outcomes are changes in leg pain intensity and disability from baseline to week 4. Secondary outcomes include back pain intensity, frequency and bothersomeness, quality of life, and global perceived effect. Adverse events will be recorded in detail. ETHICS AND DISSEMINATION Ethical approval of this trial was granted from the ethics committee of Beijing University of Chinese Medicine and all study centres (No. 2020BZYLL0803). Written informed consent will be obtained from enrolled patients. Trial results will be disseminated in peer-reviewed publications. TRIAL REGISTRATION NUMBER ChiCTR2100044585 (Chinese Clinical Trial Registry, http://www.chictr.org.cn, registered on 24 March 2021); preresults.
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Affiliation(s)
- Fang-Ting Yu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Cun-Zhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
- Departrment of Acupuncture, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Guang-Xia Ni
- School of Acupuncture-Moxibustion and Tuina, School of Health and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing, China
| | - Guo-Wei Cai
- Department of Acupuncture, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhi-Shun Liu
- Departrment of Acupuncture, Guang'an Men's Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiao-Qing Zhou
- Departrment of Acupuncture, Shenzhen Hospital of Beijing University of Chinese Medicine, Shenzhen, China
| | - Chao-Yang Ma
- Department of Rehabilitation, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiu-Li Meng
- Pain Medicine Center, Peking University Third Hospital, Beijing, China
| | - Jian-Feng Tu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - He-Wen Li
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jing-Wen Yang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Shi-Yan Yan
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Hai-Yang Fu
- Departrment of Acupuncture, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Wen-Tao Xu
- School of Acupuncture-Moxibustion and Tuina, School of Health and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jing Li
- Department of Acupuncture, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong-Chun Xiang
- Department of Acupuncture, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tian-Heng Sun
- Departrment of Acupuncture, Guang'an Men's Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Beng Zhang
- Departrment of Acupuncture, Shenzhen Hospital of Beijing University of Chinese Medicine, Shenzhen, China
| | - Mei-Hua Li
- Departrment of Acupuncture, Shenzhen Hospital of Beijing University of Chinese Medicine, Shenzhen, China
| | - Wen-Jun Wan
- Department of Rehabilitation, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cheng He
- Department of Rehabilitation, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Lan Ji
- Department of Traditional Chinese Medicine, Peking University Third Hospital, Beijing, China
| | - Wei Zhu
- Pain Medicine Center, Peking University Third Hospital, Beijing, China
| | - Guang-Xia Shi
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Li-Qiong Wang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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Pan HT, Li J, Feng CC, Pei LJ, Xi ZQ, Hou WG, Wang K. [Therapeutic effect of Fanzhen Jieci needling on discogenic sciatica: a randomized controlled trial]. Zhongguo Zhen Jiu 2022; 42:261-266. [PMID: 35272401 DOI: 10.13703/j.0255-2930.20210405-k0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To compare the therapeutic effect between Fanzhen Jieci (warming acupuncture plus fast needling) combined with conventional acupuncture and simple conventional acupuncture on discogenic sciatica. METHODS A total of 76 patients with discogenic sciatica were randomized into a Fanzhen Jieci group and a conventional acupuncture group, 38 cases in each one. Conventional acupuncture was applied at Shenshu (BL 23), Dachangshu (BL 25), L1-L5 Jiaji (EX-B 2) and Huantiao (GB 30) on the affected side, etc. in the conventional acupuncture group. On the basis of the treatment in the conventional acupuncture group, Fanzhen Jieci was applied at L1-L5 Jiaji (EX-B 2) and Huantiao (GB 30) on the affected side in the Fanzhen Jieci group, i.e. warming acupuncture was applied at L1-L5 Jiaji (EX-B 2), and fast needling was applied at Huantiao (GB 30) on the affected side for a depth of 40-60 mm, so as to introduce a sensation of electric shock transmitting to lower limb, and then the needle was immediately withdrawn. The treatment was given once every other day, 3 times a week for 3 weeks in both groups. The visual analogue scale (VAS) score of leg and low back pain, the Oswestry disability index (ODI) score and the 36-item short form health survey (SF-36) score before and after treatment were compared between the two groups. RESULTS Compared before treatment, the VAS scores of leg and low back pain and the ODI scores after treatment were decreased in both groups (P<0.001), the changes of the VAS scores of leg and low back pain in the Fanzhen Jieci group were larger than those in the conventional acupuncture group (P<0.05). After treatment, except for the role emotional and health transition scores, the various scores of SF-36 were increased compared before treatment in the Fanzhen Jieci group (P<0.01); except for the role physical, role emotional and health transition scores, the various scores of SF-36 were increased compared before treatment in the conventional acupuncture group (P<0.01). After treatment, the physical functioning, role physical, bodily pain, mental health and general health scores of SF-36 in the Fanzhen Jieci group were higher than those in the conventional acupuncture group (P<0.05). CONCLUSION Fanzhen Jieci combined with conventional acupuncture can effectively relieve the pain and improve the mental state in patients with discogenic sciatica, its therapeutic effect is superior to simple conventional acupuncture.
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Affiliation(s)
- Hao-Tian Pan
- Acupuncture Anesthesia Clinical Research Institute, Shanghai University of TCM, Shanghai 200437, China; Yueyang Clinical Medical College, Shanghai University of TCM, Shanghai 201203
| | - Jing Li
- Acupuncture Anesthesia Clinical Research Institute, Shanghai University of TCM, Shanghai 200437, China; Department of Acupuncture and Moxibustion, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of TCM, Shanghai 200437, China
| | - Chen-Chen Feng
- Acupuncture Anesthesia Clinical Research Institute, Shanghai University of TCM, Shanghai 200437, China; Yueyang Clinical Medical College, Shanghai University of TCM, Shanghai 201203
| | - Li-Juan Pei
- Acupuncture Anesthesia Clinical Research Institute, Shanghai University of TCM, Shanghai 200437, China; Yueyang Clinical Medical College, Shanghai University of TCM, Shanghai 201203
| | - Zi-Qi Xi
- Acupuncture Anesthesia Clinical Research Institute, Shanghai University of TCM, Shanghai 200437, China; Yueyang Clinical Medical College, Shanghai University of TCM, Shanghai 201203
| | - Wen-Guang Hou
- Acupuncture Anesthesia Clinical Research Institute, Shanghai University of TCM, Shanghai 200437, China; Department of Acupuncture and Moxibustion, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of TCM, Shanghai 200437, China
| | - Ke Wang
- Acupuncture Anesthesia Clinical Research Institute, Shanghai University of TCM, Shanghai 200437, China
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Shi M, Zhang X, Wang S, Li S, Zhao C, Li Z, Li J. Efficacy and safety of Daoyin and massage for lumbar disc herniation: A protocol for overview of systematic reviews. Medicine (Baltimore) 2022; 101:e28775. [PMID: 35119041 PMCID: PMC8812663 DOI: 10.1097/md.0000000000028775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/20/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Lumbar disc herniation (LDH) is a common disease, which can cause low back pain, sciatica, and even disability. The treatment of LDH is a global challenge. Conservative therapy with non-drugs is considered to be the first choice for patients with LDH. In recent years, an increasing number of systematic reviews and meta analyses on Daoyin and massage interventions in lumbar disc herniation have been implemented. However, the evidence quality and methodological quality of these systematic reviews/meta analyses are unknown and need to be systematically evaluated. This overview aims to systematically summarize and critically appraise the current evidence on Daoyin and massage for LDH. METHODS Eight electronic data will be retrieved, including China National Knowledge Infrastructure (CNKI), Wanfang database (WF), China Biomedical database (CBM), Chinese Scientific Journals Database (VIP), PubMed, Cochrane Library, Web of Science (WOS), and EMBASE from their inception to March 1, 2022. The reporting quality, methodological quality, risk of bias, quality of evidence will be assessed by using The Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 (PRISMA 2020), the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2), the Risk of Bias in Systematic Review (ROBIS), and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Two independent researchers conducted literature screening, data extraction, and quality evaluation process. In addition, we will establish an overlap matrix and calculate the corrected covered area to evaluate the impact of overlapping areas on conclusions. RESULTS The results will be published in a peer-reviewed journal. CONCLUSION This overview will provide comprehensive evidence of Daoyin and massage for treating lumbar disc herniation. SYSTEMATIC REVIEW REGISTRATION INPLASY202210019.
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Affiliation(s)
| | | | - Siyi Wang
- Changchun University of Chinese Medicine, China
| | - Shaojun Li
- Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Changwei Zhao
- Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Zhenhua Li
- Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
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Kontakiotis N, Rushton AB, Billis E, Papathanasiou G, Gioftsos G. Development of a clinical prediction model to inform clinical decision making for classification of patients with sciatica, based on their clinical characteristics, in the Greek health system: protocol for a prospective predictive exploratory study. BMJ Open 2022; 12:e052119. [PMID: 35105622 PMCID: PMC8804639 DOI: 10.1136/bmjopen-2021-052119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Sciatica is one of the most common reasons for seeking healthcare for musculoskeletal pain. Sciatica is primarily considered as neuropathic in nature when neural tissue in the low back is compromised, but sometimes other non-neural structures may be involved. Appropriate assessment and management are important for patients with sciatica. Therapists use several outcome measures to assess patients to inform selection of the most suitable treatment. There is limited evidence for the best treatment of sciatica, and this is likely contributed to by having no reliable algorithm to categorise patients based on their clinical characteristics to inform physiotherapy treatment. The purpose of this study is to develop a clinical prediction model to categorise patients with sciatica, in terms of early clinical outcome, based on their initial clinical characteristics. METHODS AND ANALYSIS A prospective observational multicentre design will recruit consecutive patients (n=467) with sciatica referred for physiotherapy. Each patient will be evaluated to determine whether or not they will be accepted into the study by answering some questions that will confirm the study's eligibility criteria. Patients' basic characteristics, patient-reported outcome measures and performance-based measures will be collected at baseline from multiple sites in the Greek territory using this same protocol, prior to commencement of treatment. The main researcher of this study will be responsible for data collection in all sites. On completion of the standard referred physiotherapy treatment after 3 weeks' time, participants will be asked by telephone to evaluate their outcome using the Global Perceived Effect Scale. For the descriptive statistical analysis, the continuous variables will be expressed in the form of 'mean' and 'SD'. In order to assess the prognostic value of each predictor, in terms of the level of improvement or worsening of the symptoms, multiple variable regression analysis will be used. ETHICS AND DISSEMINATION Τhis study is approved from the Ethics and Deontology Committee of the University of West Attica, Athens, Greece, protocol number: 38313-09/06/2020, 10226-10/02/2021. The study's findings will be published in a peer-reviewed journal and disseminated at national and international conferences and through social media. PROSPERO REGISTRATION NUMBER CRD42020168467.
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Affiliation(s)
- Nikolaos Kontakiotis
- Physiotherapy Department, Laboratory of Advanced Physiotherapy, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
| | - Alison B Rushton
- School of Physical Therapy, Western University Faculty of Health Sciences, London, Ontario, Canada
| | - Evdokia Billis
- Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, Patra, Greece
| | - George Papathanasiou
- Physiotherapy Department, Laboratory of Neuromuscular and Cardiovascular Study of Motion, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
| | - George Gioftsos
- Physiotherapy Department, Laboratory of Advanced Physiotherapy, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
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Yan H, An Y, Zhang T, Zhao J, Yan J. Therapeutic effect and safety of Tuina on sciatica: A protocol for systematic review and meta-analysis∗. Medicine (Baltimore) 2021; 100:e28097. [PMID: 35049236 PMCID: PMC9191340 DOI: 10.1097/md.0000000000028097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Sciatica is one of the common pain symptoms in the human body, also known as radiating leg pain. Sciatica is increasingly occurring due to poor posture and lack of physical exercise all over the world. At present, many studies have indicated that Tuina can improve the clinical symptoms and functional status of sciatica. However, there is currently no relevant systematic review to evaluate and report this clinical scientific issue. Consequently, this study will conduct a meta-analysis on the effectiveness and safety of Tuina therapy for sciatica. METHODS AND ANALYSIS Randomized controlled trials (RCTs) related to Tuina treatment of sciatica will be retrieved from the Chinese and English databases and Clinical Trial Register. These databases include China National Knowledge Infrastructure, Wan Fang Database, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, PubMed, Embase, Web of Science, Cochrane Library, and Medline, etc. We will consider articles published in English or Chinese between database initiation and October 2021. Our team will use Review Manager Software 5.3 software provided by the Cochrane Collaborative Network to conduct this systematic review and meta-analysis. RESULTS This study provides a comprehensive evaluation of the effectiveness and safety of Tuina therapy for sciatica. CONCLUSION The conclusion of our study will provide scientific evidence and reference to determine whether Tuina is an effective and safe intervention for patients with sciatica. REGISTRATION NUMBER INPLASY2021100034.
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Han Z, Li X, Liu Z, Bai M, Zhao Z, Wang J. The study on the clinical effectiveness and safety of traditional Chinese medicine acupoint catgut embedding guided by musculoskeletal ultrasound in the treatment of nerve root sciatica: A protocol for systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e25387. [PMID: 33787646 PMCID: PMC8021314 DOI: 10.1097/md.0000000000025387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/14/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Nerve root sciatica (NRS) is a common orthopedic disease, which usually occurs between 20 and 40 years of age, and the incidence rate is increasing year by year and is being younger. The disease has no special effect of treatment, clinically generally taking the symptomatic treatment, such as taking short-term glucocorticoids, sedatives, analgesics, and so on. Long-term use of drugs will adversely affect the patient's gastrointestinal tract, liver, and kidney function. The surgical treatment has a high risk of surgery, high cost, side effects, and other problems, so the choice of treatment method has always been a difficult problem in clinical and scientific research. The study shows that 90% of patients with sciatica can be cured by non-surgical treatment, so conservative therapy is often used in the treatment of sciatica, traditional Chinese medicine treatment methods in the treatment of NRS has been widely used, which has achieved good results, but there is no evidence of evidence-based medicine. Therefore, this study uses systematic evaluation to conduct the scientific evaluation of the clinical effectiveness and safety of traditional Chinese medicine acupoint catgut embedding guided by musculoskeletal ultrasound in the treatment of NRS, and provide evidence-based medical evidence support for the treatment of NRS. METHODS Using the computer to retrieve the PubMed, ScienceDirect, Web of Science, Embase, Cochrane Library, CNKI, VIP, WANFANG Database, and CBM. Using the subject words and terminology words to retrieve the Chinese-English database and retrieve a randomized controlled study on the clinical effectiveness and safety of traditional Chinese medicine acupoint catgut embedding guided by musculoskeletal ultrasound in the treatment of NRS, and the range of search time is January 1990 to January 2021. The searched literature is screened and evaluated by two researchers respectively according to the inclusion and exclusion criteria. If there is disagreement, discussing it with the third researcher to determine the final inclusion of the literature. Using the RevMan 5.3 software to conduct the meta-analysis. RESULTS This study will compare the effectiveness and safety of traditional Chinese medicine acupoint catgut embedding guided by musculoskeletal ultrasound in the treatment of NRS. CONCLUSION The results of this study will be published in internationally influential academic journals to provide evidence-based medical evidence for the clinical effectiveness and safety of traditional Chinese medicine acupoint catgut embedding in the treatment of NRS. ETHICS AND DISSEMINATION This study does not involve specific patients, and all research data comes from publicly available professional literature, so an ethics committee is not required to conduct an ethical review and approval of the study. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/Q492E.
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Affiliation(s)
| | - Xiaowei Li
- Department of Anesthesiology, Inner Mongolia Baogang Hospital (The Third Affiliated Hospital of Inner Mongolia Medical University), No. 20 Shaoxian Road, Kundulun District, Baotou 014010, Inner Mongolia Autonomous Region, China
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Cao F, He X, Guo C, Wang J, Zeng R, Lu L, Meng F, Zhao F, Wang C. Warm acupuncture therapy for Primary sciatica: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24551. [PMID: 33663061 PMCID: PMC7909147 DOI: 10.1097/md.0000000000024551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION This meta-analysis aims to assess the effectiveness and safety of warm acupuncture therapy for treating Primary sciatica. METHODS The following 9 databases will be search from their inception to December 6, 2020: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese Biomedical Literature Database (CBM), the Chinese Medical Current Content (CMCC), the Wan-Fang Database and the China National Knowledge Infrastructure (CNKI). Randomized controlled trials (RCTs) of warm acupuncture for treating Primary sciatica, Chinese or Japanese without restriction of publication status will be included. Two researchers will independently undertake study selection, extraction of data and assessment of study quality. Meta-analysis will be conducted after screening of studies. Data will be analyzed using risk ratio for dichotomous data, and standardized mean difference or weighted mean difference for continuous data. DISSEMINATION This meta-analysis will be disseminated electronically through a peer-reviewed publication or conference presentations. CONCLUSION This study will provide evidence to judge whether warm acupuncture. TRIAL REGISTRATION NUMBER INPLASY2020120109.
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Affiliation(s)
- Fang Cao
- Jiangxi University of Traditional Chinese Medicine
| | - XingWei He
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Cui Guo
- Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - JingWei Wang
- Jiangxi University of Traditional Chinese Medicine
| | - RuiLin Zeng
- Jiangxi University of Traditional Chinese Medicine
| | - LunBin Lu
- Jiangxi University of Traditional Chinese Medicine
| | - FanLei Meng
- Jiangxi University of Traditional Chinese Medicine
| | - Fenfen Zhao
- Jiangxi University of Traditional Chinese Medicine
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Zhang J, Xie Y, Li J, Yuan M, Yu Z, Su Y, Dai Q, Liu Y. Effectiveness and safety of warm needle acupuncture for sciatica: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24126. [PMID: 33466184 PMCID: PMC7808512 DOI: 10.1097/md.0000000000024126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/09/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Sciatica is a syndrome characterized by sciatic nerve path and distribution area pain. Many kinds of literature reported the definite effect of warm needle acupuncture (WNA) on sciatica. However, there is no systematic review or meta-analysis on WNA for sciatica. Therefore, this study will design a protocol to comprehensively and systematically evaluate the effectiveness and safety of WNA on sciatica. METHODS The two researchers in this study will search the electronic database for randomized controlled trials, (RCTs) of WNA on sciatica, The databases we will search include PubMed, EMBASE, Cochrane Library, Web of Science, Chinese national knowledge infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Database, and Chinese biomedical literature database (CBM). Review Manager 5.4 software and Cochrane risk bias tool will be us used for data analysis and to evaluate research quality. The main clinical indicators will include visual analogue scale (VAS) and Oswestry Disability Index (ODI). RESULTS This study will evaluate the efficacy and safety of WNA for sciatica. CONCLUSION This study will provide a reliable scheme for objectively and comprehensively evaluating the efficacy and safety of WNA on sciatica. TRIAL REGISTRATION NUMBER INPLASY2020110074.
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Zhang Y, Zhang Y, Chen X, Xu K, Huang M, Tan S, Zhou Z. Acupoint catgut embedding for the treatment of sciatica: A protocol for a systematic review. Medicine (Baltimore) 2021; 100:e23951. [PMID: 33429754 PMCID: PMC7793315 DOI: 10.1097/md.0000000000023951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Sciatica is a common and frequent peripheral neuropathic pain disease, which causes a great burden on peoples life. Recently, acupoint catgut embedding (ACE) has been widely applied for treating sciatica in China, however, there is no enough evidence to prove the efficiency and safety of ACE for sciatica. Our study aims to evaluate the efficiency and safety of ACE for sciatica. METHODS AND ANALYSIS Searches of the Cochrane Library, PubMed, Springer Medline, EMBASE, China National Knowledge Infrastructure (CNKI), Wan-Fang Data (WANFANG), Chinese Biomedical Literature Database (CBM), and Chinese Scientific Journal Database (VIP databases) will be performed from inception to November 2020. The main outcomes are the pain intensity and the whole efficiency assessment. The secondary outcomes will include Oswestry Disability Index (ODI), life quality, physical examination, and adverse events. Two reviewers will separately conduct the study selection, data extraction and study quality assessments. RevMan 5.3 software will be used for meta-analysis. RESULTS This study will provide an evidence-based review of acupoint catgut embedding therapy for sciatica according to the pain intensity, the whole efficiency assessment, life quality, DOI index and adverse events. CONCLUSIONS This systematic review will present the current evidence for acupoint catgut embedding therapy for sciatica. ETHICS AND DISSEMINATION Ethical approval is unnecessary as this protocol is only for systematic review and does not involve privacy data. The findings of this study will be disseminated electronically through a peer-review publication or presented at a relevant conference. TRIAL REGISTRATION NUMBER INPLASY2020110087.
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Affiliation(s)
- Yingrong Zhang
- Hubei University of Chinese Medicine/The Co-innovation Center for Preventive Treatment of Disease of Acupuncture-moxibustion in Hubei Province
| | - Yanji Zhang
- Hubei University of Chinese Medicine/The Co-innovation Center for Preventive Treatment of Disease of Acupuncture-moxibustion in Hubei Province
| | - Xia Chen
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine
- Hubei Province Academy of Traditional Chinese Medicine, Wuhan, China
| | - Kou Xu
- Hubei University of Chinese Medicine/The Co-innovation Center for Preventive Treatment of Disease of Acupuncture-moxibustion in Hubei Province
| | - Mengyuan Huang
- Hubei University of Chinese Medicine/The Co-innovation Center for Preventive Treatment of Disease of Acupuncture-moxibustion in Hubei Province
| | - Sanchun Tan
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine
- Hubei Province Academy of Traditional Chinese Medicine, Wuhan, China
| | - Zhongyu Zhou
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine
- Hubei Province Academy of Traditional Chinese Medicine, Wuhan, China
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Furlong B, Aubrey-Bassler K, Etchegary H, Pike A, Darmonkow G, Swab M, Hall A. Patient education materials for non-specific low back pain and sciatica: a protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e039530. [PMID: 32878763 PMCID: PMC7470487 DOI: 10.1136/bmjopen-2020-039530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/11/2020] [Accepted: 07/01/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Low back pain accounts for more disability than any other musculoskeletal condition and is associated with severe economic burden. Patients commonly present with negative beliefs about low back pain and this can have detrimental effects on their health outcomes. Providing evidence-based, patient-centred education that meets patient needs could help address these negative beliefs and alleviate the substantial low back pain burden. The primary aim of this review is to investigate the effectiveness of patient education materials on immediate process, clinical and health system outcomes. METHODS AND ANALYSIS The search strategy was developed in collaboration with a librarian and systematic searches will be performed in MEDLINE, EMBASE, CINAHL, PsycINFO and SPORTDiscus. We will also search trial registries and grey literature through the OpenGrey database. Study selection will include a title and abstract scan and full-text review by two authors. Only randomised controlled trials will be included in this review. Trials must include patients with low back pain or sciatica and investigate educational interventions with at least one of the following contrasts: (1) education alone versus no intervention; (2) education alone versus another intervention; (3) education in addition to another intervention versus the same intervention with no education. Data extraction, risk of bias and grading of the quality of evidence will be performed independently by two reviewers. Risk of bias will be assessed using the PEDro scale, and the quality of evidence will be assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach. A random-effects model will be used for each contrast, and results will be pooled if the participants, interventions, and outcomes are homogeneous. If heterogeneity is high (I2 >75%), we will evaluate the magnitude and direction of the differences in effect sizes across studies to determine if it remains reasonable to pool the results. Analyses of acute and subacute low back pain (less than 12 weeks duration) will be performed separately from chronic low back pain (12 weeks or greater duration). Likewise, analyses of short-term (less than 6 months) and long-term (6 months or greater) follow-up will be performed separately. Subgroup analyses will be performed on non-specific low back pain, sciatica and mixed populations. ETHICS AND DISSEMINATION Ethical approval is not required for this review. This study, along with its results, will be published in a peer-reviewed journal.
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Affiliation(s)
- Bradley Furlong
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Holly Etchegary
- Clinical Epidemiology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Andrea Pike
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Georgia Darmonkow
- Clinical Epidemiology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Michelle Swab
- Health Sciences Library, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Amanda Hall
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St John's, Newfoundland, Canada
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Saunders B, Konstantinou K, Artus M, Foster NE, Bartlam B. Patients' and clinicians' perspectives on a 'fast-track' pathway for patients with sciatica in primary care: qualitative findings from the SCOPiC stratified care trial. BMC Musculoskelet Disord 2020; 21:469. [PMID: 32680487 PMCID: PMC7367249 DOI: 10.1186/s12891-020-03483-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Sciatica is common and associated with significant impacts for the individual and society. The SCOPiC randomised controlled trial (RCT) (trial registration: ISRCTN75449581 ) tested stratified primary care for sciatica by subgrouping patients into one of three groups based on prognostic and clinical indicators. Patients in one group were 'fast-tracked' for a magnetic resonance imaging (MRI) scan and spinal specialist opinion. This paper reports qualitative research exploring patients' and clinicians' perspectives on the acceptability of this 'fast-track' pathway. METHODS Semi-structured interviews were conducted with 20 patients and 20 clinicians (general practitioners, spinal specialist physiotherapists, spinal surgeons). Data were analysed thematically and findings explored using Normalisation Process Theory (NPT) and 'boundary objects' concept. RESULTS Whilst the 'fast-track' pathway achieved a degree of 'coherence' (i.e. made sense) to both patients and clinicians, particularly in relation to providing early reassurance based on MRI scan findings, it was less 'meaningful' to some clinicians for managing patients with acute symptoms, reflecting a reluctance to move away from the usual 'stepped care' approach. Both groups felt a key limitation of the pathway was that it did not shorten patient waiting times between their spinal specialist consultation and further treatments. CONCLUSION Findings contribute new knowledge about patients' and clinicians' perspectives on the role of imaging and spinal specialist opinion in the management of sciatica, and provide important insights for understanding the 'fast-track' pathway, as part of the stratified care model tested in the RCT. Future research into the early referral of patients with sciatica for investigation and specialist opinion should include strategies to support clinician behaviour change; as well as take into account the role of imaging in providing reassurance to patients with severe symptoms in cases where imaging reveals a clear explanation for the patient's pain, and where this is accompanied by a thorough explanation from a trusted clinical expert.
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Affiliation(s)
- Benjamin Saunders
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG, UK.
| | - Kika Konstantinou
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG, UK
- Haywood Hospital, Midlands Partnership Foundation NHS Trust, Staffordshire, UK
| | - Majid Artus
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG, UK
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG, UK
- Keele Clinical Trials Unit (CTU), David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK
| | - Bernadette Bartlam
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG, UK
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Abstract
OBJECTIVES Amid a political agenda for integrated, high-value care, the UK is implementing its Low Back and Radicular Pain Pathway. To align care with need, it is imperative to understand the patients' perspective. The purpose of this study was, therefore, to explore how people experience being managed for sciatica within an National Health Service (NHS) pathway. DESIGN Qualitative interpretative study. SETTING Musculoskeletal Service in an NHS, Primary Care Trust, UK. PARTICIPANTS The sample comprised 14 people aged ≥18 years with a clinical presentation of sciatica, who were currently under the care of a specialist physiotherapist (the specialist spinal triage practitioner), had undergone investigations (MRI) and received the results within the past 6 weeks. People were excluded if they had previously undergone spinal surgery or if the suspected cause of symptoms was cauda equina syndrome or sinister pathology. Participants were sampled purposively for variation in age and gender. Data were collected using individual semi-structured interviews (duration: 38-117 min; median: 82.6 min), which were audio-recorded and transcribed verbatim. Data were analysed thematically. RESULTS A series of problems with the local pathway (insufficient transparency and information; clinician-led decisions; standardised management; restricted access to specialist care; and a lack of collaboration between services) made it difficult for patients to access the management they perceived necessary. Patients were therefore required to be independent and proactive or have agency. This was, however, difficult to achieve (due to the impact of sciatica and because patients lacked the necessary skills, funds and support) and together with the pathway issues, this negated patients' capability to manage sciatica. CONCLUSIONS This novel paper explores how patients experience the process of being managed within a sciatica pathway. While highlighting the need to align with recommended best practice, it shows the need to be more person-centred and to support and empower patient agency. TRIAL REGISTRATION NUMBER ClinicalTrials.gov reference (UOS-2307-CR); Pre-results.
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Affiliation(s)
- Clare Ryan
- Physiotherapy Service, Solent NHS Trust, Portsmouth, Hampshire, UK
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Catherine J Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Lisa Roberts
- School of Health Sciences, University of Southampton, Southampton, UK
- Therapy Services Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Lee YJ, Kim J, Kim MR, Kim J, Kim MY, Cho HW, Lee SH, Ha I. Observational study on effectiveness and safety of integrative Korean medicine treatment for inpatients with sciatica due to lumbar intervertebral disc herniation. Medicine (Baltimore) 2020; 99:e20083. [PMID: 32481274 PMCID: PMC7249894 DOI: 10.1097/md.0000000000020083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We developed a protocol for a prospective registry to prove the effectiveness and safety of integrative Korean medicine treatment for inpatients with sciatica due to lumbar intervertebral disc herniation. We plan on recruiting 1000 inpatients receiving integrative Korean medicine treatment for lumbar intervertebral disc herniation at four spine specialized Korean medical hospitals. Patients enrolled in the registry will be evaluated at the time of hospitalization, 2 weeks after hospitalization, at discharge, and 6 months after hospitalization on predefined outcome variables such as intensity of back and leg pain, Oswestry Disability Index, quality of life, Patient Global Impression of Change, and adverse effects. The protocol of this study was registered in CRIS (KCT0003709) and Clinical trial gov (NCT03750591). This study is significant in that it cannot only be a basis for safety-related evidence of complementary alternative medicine, which has been lacking, but it also gives clear evidence on the effectiveness and validity of treatment effects such as accompaniment of stenosis, sex, age, and type of disc herniation.
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Affiliation(s)
- Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation
| | - Jongho Kim
- Jaseng Hospital of Korean Medicine, Seoul
| | | | - Joowon Kim
- Bucheon Jaseng Hospital of Korean Medicine, Gyeonggi-do
| | | | - Hyun-Woo Cho
- Haeundae Jaseng Hospital of Korean Medicine, Busan, Republic of Korea
| | - Sook-Hyun Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation
| | - Inhyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation
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Neto T, Freitas SR, Andrade RJ, Vaz JR, Mendes B, Firmino T, Bruno PM, Nordez A, Oliveira R. Shear Wave Elastographic Investigation of the Immediate Effects of Slump Neurodynamics in People With Sciatica. J Ultrasound Med 2020; 39:675-681. [PMID: 31633231 DOI: 10.1002/jum.15144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/28/2019] [Accepted: 09/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Neurodynamic techniques are often used to treat people with sciatica pain, but their mechanical effects on the sciatic nerve are unknown. Shear wave elastography (SWE) has been shown to effectively estimate the stiffness of peripheral nerves in real time. The aim of this study was to use SWE to assess the effects of slump neurodynamics in the sciatic stiffness of people with sciatica. METHODS Sixteen participants volunteered for this study. The sciatic stiffness of 8 patients with unilateral chronic sciatica and 8 healthy control participants was measured by SWE, with the participants in a prone position and during a dynamic condition (ie, ankle dorsiflexion). These measurements were performed before and immediately after the neurodynamic intervention, which consisted of a static slump position applied to the symptomatic limb of the patients with sciatica and in a randomly chosen limb of the healthy participants. RESULTS The 8 patients with sciatica included 6 male and 2 female patients, and the 8 healthy control participants included 5 male and 3 female volunteers. Slump neurodynamics resulted in an immediate decrease in the sciatic nerve stiffness of the symptomatic limb in people with sciatica by 16.1% (effect size = 0.65; P = .019). The intervention showed no significant changes in the sciatic nerve stiffness of the healthy participants (effect size = 0.05; P = .754). CONCLUSIONS Slump neurodynamics have the potential of decreasing the sciatic nerve stiffness in people with sciatica, and this effect can be quantified by SWE, which may provide valuable information for health professionals.
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Affiliation(s)
- Tiago Neto
- Department of Physiotherapy, LUNEX International University of Health, Exercise, and Sports, Differdange, Luxembourg
| | - Sandro R Freitas
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Ricardo J Andrade
- Movement, Interactions, and Performance Laboratory, Faculty of Sport Sciences, University of Nantes, Nantes, France
- Menzies Health Institute Queensland and School of Allied Health Sciences, Griffith University, Brisbane and Gold Coast, Queensland, Australia
| | - João R Vaz
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Bruno Mendes
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Telmo Firmino
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Human Performance Department, Sport Lisboa e Benfica, Lisbon, Portugal
| | - Paula M Bruno
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Antoine Nordez
- Movement, Interactions, and Performance Laboratory, Faculty of Sport Sciences, University of Nantes, Nantes, France
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Raúl Oliveira
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
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22
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Bailey CS, Rasoulinejad P, Taylor D, Sequeira K, Miller T, Watson J, Rosedale R, Bailey SI, Gurr KR, Siddiqi F, Glennie A, Urquhart JC. Surgery versus Conservative Care for Persistent Sciatica Lasting 4 to 12 Months. N Engl J Med 2020; 382:1093-1102. [PMID: 32187469 DOI: 10.1056/nejmoa1912658] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The treatment of chronic sciatica caused by herniation of a lumbar disk has not been well studied in comparison with acute disk herniation. Data are needed on whether diskectomy or a conservative approach is better for sciatica that has persisted for several months. METHODS In a single-center trial, we randomly assigned patients with sciatica that had lasted for 4 to 12 months and lumbar disk herniation at the L4-L5 or L5-S1 level in a 1:1 ratio to undergo microdiskectomy or to receive 6 months of standardized nonoperative care followed by surgery if needed. Surgery was performed by spine surgeons who used conventional microdiskectomy techniques. The primary outcome was the intensity of leg pain on a visual analogue scale (ranging from 0 to 10, with higher scores indicating more severe pain) at 6 months after enrollment. Secondary outcomes were the score on the Oswestry Disability Index, back and leg pain, and quality-of-life scores at 6 weeks, 3 months, 6 months, and 1 year. RESULTS From 2010 through 2016, a total of 790 patients were screened; of those patients, 128 were enrolled, with 64 in each group. Among the patients assigned to undergo surgery, the median time from randomization to surgery was 3.1 weeks; of the 64 patients in the nonsurgical group, 22 (34%) crossed over to undergo surgery at a median of 11 months after enrollment. At baseline, the mean score for leg-pain intensity was 7.7 in the surgical group and 8.0 in the nonsurgical group. The primary outcome of the leg-pain intensity score at 6 months was 2.8 in the surgical group and 5.2 in the nonsurgical group (adjusted mean difference, 2.4; 95% confidence interval, 1.4 to 3.4; P<0.001). Secondary outcomes including the score on the Owestry Disability Index and pain at 12 months were in the same direction as the primary outcome. Nine patients had adverse events associated with surgery, and one patient underwent repeat surgery for recurrent disk herniation. CONCLUSIONS In this single-center trial involving patients with sciatica lasting more than 4 months and caused by lumbar disk herniation, microdiskectomy was superior to nonsurgical care with respect to pain intensity at 6 months of follow-up. (Funded by Physicians' Services Incorporated Foundation; ClinicalTrials.gov number, NCT01335646.).
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Affiliation(s)
- Chris S Bailey
- From the Department of Surgery (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G., J.C.U.) and Occupational Health and Safety (R.R.), London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G.), Lawson Health Research Institute (C.S.B., P.R., J.C.U.), Regional Rehabilitation and Spinal Cord Injury Outpatients, Parkwood Institute (K.S.), and the Departments of Physical Medicine and Rehabilitation (T.M.) and Anesthesia and Perioperative Medicine (J.W.), St. Joseph's Hospital - all in London, ON, Canada
| | - Parham Rasoulinejad
- From the Department of Surgery (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G., J.C.U.) and Occupational Health and Safety (R.R.), London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G.), Lawson Health Research Institute (C.S.B., P.R., J.C.U.), Regional Rehabilitation and Spinal Cord Injury Outpatients, Parkwood Institute (K.S.), and the Departments of Physical Medicine and Rehabilitation (T.M.) and Anesthesia and Perioperative Medicine (J.W.), St. Joseph's Hospital - all in London, ON, Canada
| | - David Taylor
- From the Department of Surgery (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G., J.C.U.) and Occupational Health and Safety (R.R.), London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G.), Lawson Health Research Institute (C.S.B., P.R., J.C.U.), Regional Rehabilitation and Spinal Cord Injury Outpatients, Parkwood Institute (K.S.), and the Departments of Physical Medicine and Rehabilitation (T.M.) and Anesthesia and Perioperative Medicine (J.W.), St. Joseph's Hospital - all in London, ON, Canada
| | - Keith Sequeira
- From the Department of Surgery (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G., J.C.U.) and Occupational Health and Safety (R.R.), London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G.), Lawson Health Research Institute (C.S.B., P.R., J.C.U.), Regional Rehabilitation and Spinal Cord Injury Outpatients, Parkwood Institute (K.S.), and the Departments of Physical Medicine and Rehabilitation (T.M.) and Anesthesia and Perioperative Medicine (J.W.), St. Joseph's Hospital - all in London, ON, Canada
| | - Thomas Miller
- From the Department of Surgery (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G., J.C.U.) and Occupational Health and Safety (R.R.), London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G.), Lawson Health Research Institute (C.S.B., P.R., J.C.U.), Regional Rehabilitation and Spinal Cord Injury Outpatients, Parkwood Institute (K.S.), and the Departments of Physical Medicine and Rehabilitation (T.M.) and Anesthesia and Perioperative Medicine (J.W.), St. Joseph's Hospital - all in London, ON, Canada
| | - Jim Watson
- From the Department of Surgery (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G., J.C.U.) and Occupational Health and Safety (R.R.), London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G.), Lawson Health Research Institute (C.S.B., P.R., J.C.U.), Regional Rehabilitation and Spinal Cord Injury Outpatients, Parkwood Institute (K.S.), and the Departments of Physical Medicine and Rehabilitation (T.M.) and Anesthesia and Perioperative Medicine (J.W.), St. Joseph's Hospital - all in London, ON, Canada
| | - Richard Rosedale
- From the Department of Surgery (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G., J.C.U.) and Occupational Health and Safety (R.R.), London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G.), Lawson Health Research Institute (C.S.B., P.R., J.C.U.), Regional Rehabilitation and Spinal Cord Injury Outpatients, Parkwood Institute (K.S.), and the Departments of Physical Medicine and Rehabilitation (T.M.) and Anesthesia and Perioperative Medicine (J.W.), St. Joseph's Hospital - all in London, ON, Canada
| | - Stewart I Bailey
- From the Department of Surgery (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G., J.C.U.) and Occupational Health and Safety (R.R.), London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G.), Lawson Health Research Institute (C.S.B., P.R., J.C.U.), Regional Rehabilitation and Spinal Cord Injury Outpatients, Parkwood Institute (K.S.), and the Departments of Physical Medicine and Rehabilitation (T.M.) and Anesthesia and Perioperative Medicine (J.W.), St. Joseph's Hospital - all in London, ON, Canada
| | - Kevin R Gurr
- From the Department of Surgery (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G., J.C.U.) and Occupational Health and Safety (R.R.), London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G.), Lawson Health Research Institute (C.S.B., P.R., J.C.U.), Regional Rehabilitation and Spinal Cord Injury Outpatients, Parkwood Institute (K.S.), and the Departments of Physical Medicine and Rehabilitation (T.M.) and Anesthesia and Perioperative Medicine (J.W.), St. Joseph's Hospital - all in London, ON, Canada
| | - Fawaz Siddiqi
- From the Department of Surgery (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G., J.C.U.) and Occupational Health and Safety (R.R.), London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G.), Lawson Health Research Institute (C.S.B., P.R., J.C.U.), Regional Rehabilitation and Spinal Cord Injury Outpatients, Parkwood Institute (K.S.), and the Departments of Physical Medicine and Rehabilitation (T.M.) and Anesthesia and Perioperative Medicine (J.W.), St. Joseph's Hospital - all in London, ON, Canada
| | - Andrew Glennie
- From the Department of Surgery (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G., J.C.U.) and Occupational Health and Safety (R.R.), London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G.), Lawson Health Research Institute (C.S.B., P.R., J.C.U.), Regional Rehabilitation and Spinal Cord Injury Outpatients, Parkwood Institute (K.S.), and the Departments of Physical Medicine and Rehabilitation (T.M.) and Anesthesia and Perioperative Medicine (J.W.), St. Joseph's Hospital - all in London, ON, Canada
| | - Jennifer C Urquhart
- From the Department of Surgery (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G., J.C.U.) and Occupational Health and Safety (R.R.), London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G.), Lawson Health Research Institute (C.S.B., P.R., J.C.U.), Regional Rehabilitation and Spinal Cord Injury Outpatients, Parkwood Institute (K.S.), and the Departments of Physical Medicine and Rehabilitation (T.M.) and Anesthesia and Perioperative Medicine (J.W.), St. Joseph's Hospital - all in London, ON, Canada
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Affiliation(s)
- Rikke K Jensen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Alice Kongsted
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Per Kjaer
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Health Sciences Research Center, University College Lillebaelt, Odense, Denmark
| | - Bart Koes
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of General Practice, Erasmus Medical Centre, Rotterdam, Netherlands
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Oosterhuis T, Smaardijk VR, Kuijer PPF, Langendam MW, Frings-Dresen MHW, Hoving JL. Systematic review of prognostic factors for work participation in patients with sciatica. Occup Environ Med 2019; 76:772-779. [PMID: 31296665 PMCID: PMC6817989 DOI: 10.1136/oemed-2019-105797] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/28/2019] [Accepted: 06/06/2019] [Indexed: 12/05/2022]
Abstract
Sciatica impacts on the ability to work and may lead to a reduced return to work. This study reviewed and summarised prognostic factors of work participation in patients who received conservative or surgical treatment for clinically diagnosed sciatica. We searched MEDLINE, CINAHL, EMBASE and PsycINFO until January 2018. Cohort studies, using a measure of work participation as outcome, were included. Two independent reviewers performed study inclusion and used the Quality In Prognosis Studies tool for risk of bias assessment and GRADE to rate the quality of the evidence. Based on seven studies describing six cohorts (n=1408 patients) that assessed 21 potential prognostic factors, favourable factors for return to work (follow-up ranging from 3 months to 10 years) included younger age, better general health, less low back pain or sciatica bothersomeness, better physical function, negative straight leg raise-test, physician expecting surgery to be beneficial, better pain coping, less depression and mental stress, less fear of movement and low physical work load. Study results could not be pooled. Using GRADE, the quality of the evidence ranged from moderate to very low, with downgrading mainly for a high risk of bias and imprecision. Several prognostic factors like pain, disability and psychological factors were identified and reviewed, and these could be targeted using additional interventions to optimise return to work. PROSPERO registration number: CRD42016042497.
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Affiliation(s)
- Teddy Oosterhuis
- Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Veerle R Smaardijk
- Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - P Paul Fm Kuijer
- Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Miranda W Langendam
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Monique H W Frings-Dresen
- Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jan L Hoving
- Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Verheijen E, Munts AG, van Haagen O, de Vries D, Dekkers O, van den Hout W, Vleggeert-Lankamp C. Transforaminal epidural injection versus continued conservative care in acute sciatica (TEIAS trial): study protocol for a randomized controlled trial. BMC Neurol 2019; 19:216. [PMID: 31481010 PMCID: PMC6719366 DOI: 10.1186/s12883-019-1445-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/25/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Sciatica is a condition that is characterised by radicular pain in the leg and primarily caused by a herniated lumbar intervertebral disk. In addition to leg pain, patients can experience back pain, leg numbness and leg weakness resulting in decreased productivity and social activity. The majority of sciatica cases recovers spontaneously and therefore patients are initially treated conservatively with oral pain medication. However, some patients experience intractable pain that severely impedes them and no consensus exists on the optimal conservative treatment to reduce this discomfort in the acute phase of sciatica. The aim of the TEIAS trial is to assess the effectiveness, cost-effectiveness and predictive capability on patient outcome of transforaminal epidural injection (TEI) compared to treatment with standard pain medication. METHODS This study is designed as a prospective, open-label, mono-centered, randomized controlled trial. Patients that visit their general practitioner with complaints of radicular leg pain and meet the selection criteria are asked to participate in this study. Eligible patients will be randomized to treatment with TEI or to treatment with standard oral pain medication. Treatment of TEI will comprise lidocaine with methylprednisolone acetate for L3 and below and lidocaine with dexamethasone above L3. A total of 142 patients will be recruited and follow-up will occur after 1, 2, 4, 10 and 21 weeks for assessment of pain, functionality, patient received recovery and cost-effectiveness. The primary outcome will be the average score for leg pain at 2 weeks. For this outcome we defined a clinically relevant difference as 1.5 on the 11-point NRS scale. DISCUSSION Adequate conservative treatment in the acute phase of sciatica is lacking, particularly for patients with severe symptoms. Focusing on effectiveness, cost-effectiveness and predictive capability on patient outcome of TEI will produce useful information allowing for more lucid decision making in the conservative treatment of sciatica in the acute phase. TRIAL REGISTRATION This trial is registered in the ClinicalTrials.gov database under registry number NCT03924791 on April 23, 2019.
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Affiliation(s)
- Eduard Verheijen
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, PO Box 9600. 2300, RC Leiden, The Netherlands
| | - Alexander G. Munts
- Department of Neurology, Spaarne Gasthuis, Haarlem, /Hoofddorp, The Netherlands
| | - Oscar van Haagen
- Department of Anaesthesiology, Spaarne Gasthuis, Haarlem, /Hoofddorp, The Netherlands
| | - Dirk de Vries
- Department of Anaesthesiology, Spaarne Gasthuis, Haarlem, /Hoofddorp, The Netherlands
| | - Olaf Dekkers
- Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilbert van den Hout
- Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
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Inoue M, Hojo T, Yano T, Katsumi Y. Electroacupuncture Direct to Spinal Nerves as an Alternative to Selective Spinal Nerve Block in Patients with Radicular Sciatica – a Cohort Study. Acupunct Med 2018; 23:27-30. [PMID: 15844437 DOI: 10.1136/aim.23.1.27] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We applied electroacupuncture to the spinal nerve root by inserting needles under x ray imaging in three cases with radicular sciatica, as a non-pharmacological substitute for lumbar spinal nerve block. In all three cases, symptoms were markedly reduced immediately after electroacupuncture to the spinal nerve root. The sustained effect was noticeably longer than that of spinal nerve blocks previously performed, in two out of the three cases. We suggest that descending inhibitory control, inhibitory control at the spinal level, inhibition of potential activity by hyperpolarisation of nerve endings, or changes in nerve blood flow may be involved in the mechanism of the effect of electroacupuncture to the spinal nerve root. These results suggest that electroacupuncture to the spinal nerve root may be superior to lumbar spinal nerve block when it is applied appropriately in certain cases of radicular sciatica, taking into consideration patient age, severity of symptoms and duration of the disorder.
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Okonkwo UP, Ibeneme SC, Ihegihu EY, Egwuonwu AV, Ezema IC, Maruf AF, Okoye EC, Ibikunle OP, Ezekwu AO. Effects of transcutaneous electrical nerve stimulation in the Management of Post-Injection Sciatic Pain in a non-randomized controlled clinical trial in Nnewi, Nigeria. BMC Complement Altern Med 2018; 18:310. [PMID: 30477485 PMCID: PMC6258320 DOI: 10.1186/s12906-018-2373-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many studies on transcutaneous electrical nerve stimulation (TENS) had been undertaken to explore its pain relieving efficiency on several medicals/surgical conditions but none, specifically, had been carried out to determine the effect it has on post-injection sciatic pain (PISP) which comes about from wrong administration of intramuscular pain. This study aims to assess the effects of TENS in the management of PISP. METHODS A total of 72 PISP subjects comprising 40 test subjects and 32 control subjects participated in a non-randomized controlled clinical trial in the current study. Participants were recruited from Department of Physiotherapy, Nnamdi Azikiwe University Teaching Hospital, Nnewi and Landmark Physiotherapy Services, Nnewi. The participants were however blinded to the intervention method they will receive before being allotted conveniently to test/experimental group (TG) or control group (CG). A written informed consent was obtained from participants before enrollments in the study. TENS and sham TENS (STENS) was applied to 40 test and 32 subjects respectively, 3 times a week, and 1 hour per session for the 10 weeks the study lasted. The Visual Analogue Scale was used to collect baseline data as well as those of 2nd, 4th, 6th, 8th and 10th weeks after TENS and STENS interventions. The data analysis was performed with the Descriptive statistic of Mean ± SD, mean comparison test, repeated analysis of variance and paired wise t-test. Statistical level of significance was set at P < 0.05. RESULT Results of repeated measure ANOVA showed that the pain level among participants in the treatment group at the end (after 10 weeks) of the intervention was significantly lower than that of their counterparts in the control group (F = 16.26; p = 0.01); with the intervention accounting for the 19% of the variance. The effect size (partial eta squared) = 0.19. CONCLUSION The outcome of this research has proved the effectiveness of TENS in the management of PISP and is being recommended in the management of PISP. TRIAL REGISTRATION Pan Africa Clinical Trial Registry ( PACTR201805003408271 ). The study was registered retrospectively on the 29th May, 2018.
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Affiliation(s)
- Uchenna Prosper Okonkwo
- Department of Physiotherapy, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State PMB 5025 Nigeria
| | - Sam Chidi Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, University of Nigeria|, Enugu Campus, Enugu State Nigeria
| | - Ebere Yvonne Ihegihu
- Department of Physiotherapy, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State PMB 5025 Nigeria
| | - Afamefuna Victor Egwuonwu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Awka, Anambra State Nigeria
| | - Ikechukwu Charles Ezema
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, University of Nigeria|, Enugu Campus, Enugu State Nigeria
| | - Adesina Fatai Maruf
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Awka, Anambra State Nigeria
| | - Emmanuel Chiebuka Okoye
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Awka, Anambra State Nigeria
| | - Olanrewaju Peter Ibikunle
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Awka, Anambra State Nigeria
| | - Antoninus Obinna Ezekwu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, University of Nigeria|, Enugu Campus, Enugu State Nigeria
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Konstantinou K, Dunn KM, Ogollah R, Lewis M, van der Windt D, Hay EM. Prognosis of sciatica and back-related leg pain in primary care: the ATLAS cohort. Spine J 2018; 18:1030-1040. [PMID: 29174459 PMCID: PMC5984249 DOI: 10.1016/j.spinee.2017.10.071] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/18/2017] [Accepted: 10/26/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Evidence is lacking on the prognosis and prognostic factors of back-related leg pain and sciatica in patients seeing their primary care physicians. This evidence could guide timely appropriate treatment and referral decisions. PURPOSE The present study aims to describe the prognosis and prognostic factors in primary care patients with low back-related leg pain and sciatica. STUDY DESIGN This is a prospective cohort study. PATIENT SAMPLE The present study included adults visiting their family doctor with back-related leg pain in the United Kingdom. OUTCOME MEASURES Information about pain, function, psychological, and clinical variables, was collected. Good outcome was defined as 30% or more reduction in disability (Roland-Morris Disability Questionnaire). METHODS Participants completed the questionnaires, underwent clinical assessments, received a magnetic resonance imaging scan, and were followed-up 12 months later. Mixed-effects logistic regression evaluated the prognostic value of six a priori defined variable sets (leg pain duration, pain intensity, neuropathic pain, psychological factors, clinical examination, and imaging variables). A combined model, including variables from all models, examined independent effects. The National Institute for Health Research funded the study. There are no conflicts of interest. RESULTS A total of 609 patients were included. At 12 months, 55% of patients improved in both the total sample and the sciatica group. For the whole cohort, longer leg pain duration (odds ratio [OR] 0.41; confidence interval [CI] 0.19-0.90), higher identity score (OR 0.70; CI 0.53-0.93), and patient's belief that the problem will last a long time (OR 0.27; CI 0.13-0.57) were the strongest independent prognostic factors negatively associated with improvement. These last two factors were similarly negatively associated with improvement in the sciatica subgroup. CONCLUSIONS The present study provides new evidence on the prognosis and prognostic factors of back-related leg pain and sciatica in primary care. Just over half of patients improved at 12 months. Patient's belief of recovery timescale and number of other symptoms attributed to the pain are independent prognostic factors. These factors can be used to inform and direct decisions about timing and intensity of available therapeutic options.
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Affiliation(s)
- Kika Konstantinou
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire ST5 5BG, United Kingdom.
| | - Kate M Dunn
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire ST5 5BG, United Kingdom
| | - Reuben Ogollah
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire ST5 5BG, United Kingdom
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire ST5 5BG, United Kingdom
| | - Danielle van der Windt
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire ST5 5BG, United Kingdom
| | - Elaine M Hay
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire ST5 5BG, United Kingdom
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Xiang A, Xu M, Liang Y, Wei J, Liu S. Immediate relief of herniated lumbar disc-related sciatica by ankle acupuncture: A study protocol for a randomized controlled clinical trial. Medicine (Baltimore) 2017; 96:e9191. [PMID: 29390461 PMCID: PMC5758163 DOI: 10.1097/md.0000000000009191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Around 90% of sciatica cases are due to a herniated intervertebral disc in the lumbar region. Ankle acupuncture (AA) has been reported to be effective in the treatment of acute nonspecific low back pain. This study aims to evaluate the efficacy of a single session of ankle acupuncture for disc-related sciatica. METHOD This will be a double-blinded, randomized controlled clinical trial. Patients diagnosed with disc-related sciatica will be randomly divided into 3 parallel groups. The treatment group (n = 30) will receive ankle acupuncture. The 2 control groups will either undergo traditional needle manipulation (n = 30) or sham acupuncture (n = 30) at the same point as the treatment group. The primary outcome will be pain intensity on a visual analog scale (VAS). The secondary outcomes will be paresthesia intensity on a VAS and the Abbreviated Acceptability Rating Profile (AAPR). The success of blinding will be evaluated, and the needle-induced sensation and adverse events will be recorded. All outcomes will be evaluated before, during, and after the treatment. DISCUSSION This study will determine the immediate effect and specificity of ankle acupuncture for the treatment of disc-related sciatica. We anticipate that ankle acupuncture might be more effective than traditional needle manipulation or sham acupuncture. TRIAL REGISTRATION ChiCTR-IPR-15007127 (http://www.chictr.org.cn/showprojen.aspx?proj=11989).
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Affiliation(s)
- Anfeng Xiang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mingshu Xu
- Shanghai Yueyang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, China
| | - Yan Liang
- Shanghai Yueyang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, China
| | - Jinzi Wei
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Sheng Liu
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Reddington M, Walters SJ, Cohen J, Baxter S. Does early intervention improve outcomes in physiotherapy management of lumbar radicular syndrome? A mixed-methods study protocol. BMJ Open 2017; 7:e014422. [PMID: 28259854 PMCID: PMC5353256 DOI: 10.1136/bmjopen-2016-014422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Lumbar radicular syndrome (LRS) can be a painful and debilitating condition. The optimum management strategies and their timing remain elusive despite extensive research. Surgery provides good short-term outcomes but has concomitant risks and costs. Physiotherapy is commonly practised for patients with LRS but its effects remain equivocal and there is a lack of consensus on the type, duration and timing of physiotherapy intervention. There is a lack of high-quality evidence into new and innovative management strategies and the timings of those strategies for LRS. This pilot trial is an essential preliminary to a definitive randomised controlled trial (RCT) assessing the effectiveness and cost-effectiveness of early physiotherapy intervention for patients with LRS. The study will test the protocol, the intervention, the use of outcome measures and the ability to set-up and run the trial to enable refinement of a future definitive RCT. METHODS AND ANALYSIS This is a mixed-methods study encompassing an external pilot RCT with integrated qualitative interviews with patients, clinicians and other key stakeholders. 80 patients will be recruited from primary care and randomised, after consent into 1 of 2 groups. Both groups will receive individually tailored, goal orientated physiotherapy. The usual care group will begin their physiotherapy 6 weeks after randomisation and the intervention group at 2 weeks after randomisation. Outcome measures will primarily be feasibility parameters including the ability to recruit and retain patients and to deliver the intervention. Data will be collected at baseline, and 6, 12 and 26 weeks following randomisation. ETHICS AND DISSEMINATION The study has received favourable ethical review from the East of Scotland Research Ethics Service (EoSRES) on the 20 August 2015 (15/ES/0130). Recruitment began on the 1 March 2016 and is expected to close in January 2017. Data collection is anticipated to be complete in July 2017. The study results will be made available to participants, clinicians involved in the study and the wider clinical community through publication in a peer reviewed journal and at conference presentations. TRIAL REGISTRATION NUMBER ISRCTN: 25018352, Pre-results; Clinical Trials.Gov: NCT02618278 Document version V1.1 23.9.2016.
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Affiliation(s)
- Michael Reddington
- Therapy Services Outpatient Department, Northern General Hospital, Sheffield, UK
| | - Stephen J Walters
- Designs, Trials and Statistics ScHARR, University of Sheffield, Sheffield, UK
| | - Judith Cohen
- Clinical Trials Research Unit ScHARR, University of Sheffield, Sheffield, UK
| | - Susan Baxter
- Section of Public Health ScHARR, University of Sheffield, Sheffield, UK
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Affiliation(s)
- Ian A Bernstein
- London North West Healthcare NHS Trust and Gordon House Surgery, London, UK
| | - Qudsia Malik
- National Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
| | - Serena Carville
- National Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
| | - Stephen Ward
- Department of Pain Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Abstract
OBJECTIVES Evidence comparing the effectiveness of surgical and conservative treatment of symptomatic lumbar disc herniation is controversial. We sought to compare short-term and long-term effectiveness of surgical and conservative treatment in sciatica symptom severity and quality of life in patients with lumbar disc herniation in a routine clinical setting. METHODS A prospective cohort study of a routine clinical practice registry consisting of 370 patients. Outcome measures were the North American Spine Society questionnaire and the 36-Item Short-Form Health Survey to assess patient-reported back pain, physical function, neurogenic symptoms and quality of life. Primary outcomes were back pain at 6 and 12 weeks. Standard open discectomy was assessed versus conservative interventions at 6, 12, 52 and 104 weeks. We filled in missing outcome variable values with multiple imputation, accounted for repeated measures within patients with mixed-effects models and adjusted baseline group differences in relevant prognostic indicators by inverse probability of treatment weighting. RESULTS Surgical treatment patients reported less back pain at 6 weeks than those receiving conservative therapy (-0.97; 95% CI -1.89 to -0.09), were more likely to report ≥50% decrease in back pain symptoms from baseline to 6 weeks (48% vs 17%, risk difference: 0.34; 95% CI 0.16 to 0.47) and reported less physical function disability at 52 weeks (-3.7; 95% CI -7.4 to -0.1). The other assessments showed minimal between-group differences with CIs, including the null effect. CONCLUSIONS Compared with conservative therapy, surgical treatment provided faster relief from back pain symptoms in patients with lumbar disc herniation, but did not show a benefit over conservative treatment in midterm and long-term follow-up.
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Affiliation(s)
| | - Bruno R da Costa
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Essam Dabis
- Department of Rheumatology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Robert Theiler
- Department of Rheumatology, Cantonal Hospital Aarau, Aarau, Switzerland
- Department of Rheumatology, Stadtspital Triemli, Zürich, Switzerland
| | - Peter Jüni
- Applied Health Research Centre (AHRC), University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephan Reichenbach
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Department of Rheumatology, Immunology and Allergology, Inselspital Bern University Hospital, Bern, Switzerland
| | - Hans Landolt
- Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Paul Hasler
- Department of Rheumatology, Cantonal Hospital Aarau, Aarau, Switzerland
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Abstract
Operative nerve-stretching was first described in 1872 to relieve incurable pain from sciatica and tabes dorsalis. It became popular for 20 years and numerous articles were published on the subject. It had many complications but relief was only transient and, consequently, it fell into disuse. This paper analyses the literature, contemporary views on the benefits of nerve stretching and its influence on more recent neurological practice.
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Qiu L, Hu XL, Zhao XY, Zheng X, Zhang J, Zhang M, He L. [A Randomized Controlled Clinical Trial of Treatment of Lumbar Disc Herniation-induced Sciatica by Acupuncture Stimulation of Sciatic Nerve Trunk]. Zhen Ci Yan Jiu 2016; 41:447-450. [PMID: 29071947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To observe the efficacy of acupuncture stimulation of the sciatic nerve trunk in the treatment of patients suffering from sciatica induced by lumbar disc herniation (LDH). METHODS A total of 60 LDH sciatica patients met the inclusion criteria were randomly divided into treatment group and control group, with 30 cases in each. Patients of the treatment group were treated by directly needling the sciatic nerve and routine acupuncture of Ashi-points, Lumbar Jiaji (EX-B 2), Dachangshu (BL 28), etc., and those of the control group treated by simple routine acupuncture. The treatment was conducted once a day, 5 times a week, 4 weeks altogether. The clinical effect was evaluated according to the "Standards for Diagnosis and Therapeutic Effect Evaluation of Syndromes of Chinese Medicine" and the pain intensity was assessed by using simplified Short-Form McGill Pain Questionnaire (SF-MPQ) containing pain rating index (PRI), visual analogue scale (VAS) and present pain intensity (PPI). RESULTS After the treatment, of the two 30 cases of LDH sciatica patients in the control and treatment groups, 11 and 18 were cured, 7 and 7 experienced marked improvement, 10 and 4 were effective, 2 and 1 was invalid, with the effective rate being 93.3% and 96.7%, respectively. The cured+markedly effective rate of the treatment group was significantly higher than that of the control group (P<0.05, 83.3% vs 60.0%). Compared with pre-treatment, the scores of PRI, VAS and PPI were evidently lowered in both groups (P<0.01), and the effect of the treatment group was notably better than that of the control group (P<0.01). CONCLUSIONS Acupuncture stimulation of the sciatic nerve trunk is effective in relieving sciatica in LDH patients, and is superior to simple routine acupuncture in the clinical efficacy.
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Affiliation(s)
- Ling Qiu
- Department of Pain, the First People's Hospital of Chengdu City, Chengdu 610041, China
| | - Xiao-Li Hu
- College of Acu-moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu 610072.
| | - Xue-Yu Zhao
- College of Acu-moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu 610072
| | - Xu Zheng
- Department of Pain, the First People's Hospital of Chengdu City, Chengdu 610041, China
| | - Ji Zhang
- Department of Pain, the First People's Hospital of Chengdu City, Chengdu 610041, China
| | - Min Zhang
- Department of Pain, the First People's Hospital of Chengdu City, Chengdu 610041, China
| | - Liu He
- Department of Pain, the First People's Hospital of Chengdu City, Chengdu 610041, China
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Starkweather A, Witek-Janusek L, Mathews HL. Neural-Immune Interactions: Implications for Pain Management in Patients with Low-Back Pain and Sciatica. Biol Res Nurs 2016; 6:196-206. [PMID: 15583360 DOI: 10.1177/1099800404272221] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bidirectional communication between the immune system and the brain and the implications of this communication are emerging concepts in pain research. Although representing a small portion of the disc degeneration syndromes, lumbar herniated discs can cause significant symptoms that may persist even after surgical interventions. Evolving evidence demonstrates that proinflammatory cytokines are a key mediator in the process of disc degeneration as well as in the pain experienced by those afflicted with lumbar herniated discs. Activated immune cells release proinflammatory cytokines, which signal the brain through humoral and neural routes. The brain responds by altering neural activity and promoting further production of proinflammatory cytokines within the brain and spinal cord. Increased local cytokine production by disc tissue irritates spinal nerve roots, resulting in pain and functional changes in neural activity. This review of the current literature explores the importance of cytokine production within the context of lumbar disc degeneration and lumbar spine pain. Furthermore, the significance of the neural-immune interaction will be examined as it relates to pain management and to patient treatment.
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Affiliation(s)
- Angela Starkweather
- Washington State University, Intercollegiate College of Nursing, 2917 West Fort George Wright Drive, Room 369, Spokane, WA 99224, USA.
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Affiliation(s)
- Richard A Deyo
- From the Departments of Family Medicine, Medicine, and Public Health and Preventive Medicine, and the Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland (R.A.D.); and the Department of Orthopaedic Surgery and the Dartmouth Institute, Dartmouth Geisel School of Medicine, Hanover, NH (S.K.M.)
| | - Sohail K Mirza
- From the Departments of Family Medicine, Medicine, and Public Health and Preventive Medicine, and the Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland (R.A.D.); and the Department of Orthopaedic Surgery and the Dartmouth Institute, Dartmouth Geisel School of Medicine, Hanover, NH (S.K.M.)
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Du X, Zhang Q. [Shu-needling at Xiaguan (ST 7) for 35 cases of primary sciatica]. Zhongguo Zhen Jiu 2015; 35:889-890. [PMID: 26721138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Zhao XY, Zhang QS, Yang J, Sun FJ, Wang DX, Wang CH, He WY. The role of arginine vasopressin in electroacupuncture treatment of primary sciatica in human. Neuropeptides 2015; 52:61-5. [PMID: 26142756 DOI: 10.1016/j.npep.2015.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
Abstract
It has been implicated that electroacupuncture can relieve the symptoms of sciatica with the increase of pain threshold in human, and arginine vasopressin (AVP) in the brain rather than the spinal cord and blood circulation participates in antinociception. Our previous study has proven that AVP in the brain played a role in the process of electroacupuncture analgesia in rat. The goal of the present study was to investigate the role of AVP in electroacupuncture in treating primary sciatica in human. The results showed that (1) AVP concentration of cerebrospinal fluid (CSF) (7.5 ± 2.5 pg/ml), not plasma (13.2 ± 4.2 pg/ml) in primary sciatica patients was lower than that in health volunteers (16.1 ± 3.8 pg/ml and 12.3 ± 3.4 pg/ml), although the osmotic pressure in CSF and plasma did not change; (2) electroacupuncture of the bilateral "Zusanli" points (St. 36) for 60 min relieved the pain sensation in primary sciatica patients; (3) electroacupuncture increased the AVP level of CSF, not plasma in primary sciatica patients; and (4) there was the positive correlation between the effect of electroacupuncture relieving the pain and the AVP level of CSF in the primary sciatica patients. The data suggested that central AVP, not peripheral AVP might improve the effect of electroacupuncture treatment of primary sciatica in human, i.e., central AVP might take part in the electroacupuncture relieving the pain sensation in primary sciatica patients.
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Affiliation(s)
- Xue-Yan Zhao
- Department of Neurology, Huaihe Hospital of Henan University, Kaifeng, Henan 475000, China
| | - Qi-Shun Zhang
- Department of Neurology, Huaihe Hospital of Henan University, Kaifeng, Henan 475000, China
| | - Jun Yang
- Standard Technological Co. Ltd. (Xinxiang Institute for New Medicine), Xinxiang, Henan 453003, China; Jiangsu Su Bei People's Hospital (Clinical College of Yangzhou University), Yangzhou, Jiangsu 225001, China; Xinjiang Nikanka Biological Co. Ltd., Hucheng, Yili, Xinjiang 835707, China.
| | - Fang-Jie Sun
- Xinjiang Nikanka Biological Co. Ltd., Hucheng, Yili, Xinjiang 835707, China
| | - Da-Xin Wang
- Jiangsu Su Bei People's Hospital (Clinical College of Yangzhou University), Yangzhou, Jiangsu 225001, China
| | - Chang-Hong Wang
- The Second Affiliated Hospital of Xinxiang Medical University (Henan Provincial Mental Hospital), Xinxiang, Henan 453002, China
| | - Wei-Ya He
- Department of Neurology, Huaihe Hospital of Henan University, Kaifeng, Henan 475000, China.
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Kanao M, Kanda H, Huang W, Liu S, Yi H, Candiotti KA, Lubarsky DA, Levitt RC, Hao S. Gene Transfer of Glutamic Acid Decarboxylase 67 by Herpes Simplex Virus Vectors Suppresses Neuropathic Pain Induced by Human Immunodeficiency Virus gp120 Combined with ddC in Rats. Anesth Analg 2015; 120:1394-404. [PMID: 25851180 DOI: 10.1213/ane.0000000000000729] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-related painful sensory neuropathies primarily consist of the HIV infection-related distal sensory polyneuropathy and antiretroviral toxic neuropathies. Pharmacotherapy provides only partial relief of pain in patients with HIV/acquired immune deficiency syndrome because little is known about the exact neuropathological mechanisms for HIV-associated neuropathic pain (NP). Hypofunction of γ-aminobutyric acid (GABA) GABAergic inhibitory mechanisms has been reported after peripheral nerve injury. In this study, we tested the hypothesis that HIV gp120 combined with antiretroviral therapy reduces spinal GABAergic inhibitory tone and that restoration of GABAergic inhibitory tone will reduce HIV-related NP in a rat model. METHODS The application of recombinant HIV-1 envelope protein gp120 into the sciatic nerve plus systemic ddC (one antiretroviral drug) induced mechanical allodynia. The hind paws of rats were inoculated with replication-defective herpes simplex virus (HSV) vectors genetically encoding gad1 gene to express glutamic acid decarboxylase 67 (GAD67), an enzyme that catalyzes the decarboxylation of glutamate to GABA. Mechanical threshold was tested using von Frey filaments before and after treatments with the vectors. The expression of GAD67 in both the lumbar spinal cord and the L4-5 dorsal root ganglia was examined using western blots. The expression of mitochondrial superoxide in the spinal dorsal horn was examined using MitoSox imaging. The immunoreactivity of spinal GABA, pCREB, and pC/EBPβ was tested using immunohistochemistry. RESULTS In the gp120 with ddC-induced neuropathic pain model, GAD67 expression mediated by the HSV vector caused an elevation of mechanical threshold that was apparent on day 3 after vector inoculation. The antiallodynic effect of the single HSV vector inoculation expressing GAD67 lasted >28 days. The area under the time-effect curves in the HSV vector expressing GAD67 was increased compared with that in the control vectors (P = 0.0005). Intrathecal GABA-A/B agonists elevated mechanical threshold in the pain model. The HSV vectors expressing GAD67 reversed the lowered GABA immunoreactivity in the spinal dorsal horn in the neuropathic rats. HSV vectors expressing GAD67 in the neuropathic rats reversed the increased signals of mitochondrial superoxide in the spinal dorsal horn. The vectors expressing GAD67 reversed the upregulated immunoreactivity expression of pCREB and pC/EBPβ in the spinal dorsal horn in rats exhibiting NP. CONCLUSIONS Based on our results, we suggest that GAD67 mediated by HSV vectors acting through the suppression of mitochondrial reactive oxygen species and transcriptional factors in the spinal cord decreases pain in the HIV-related neuropathic pain model, providing preclinical evidence for gene therapy applications in patients with HIV-related pain states.
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Affiliation(s)
- Megumi Kanao
- From the *Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida; †Department of Anesthesiology, Asahikawa Medical University, Asahikawa, Japan; ‡Hussman Institute of Human Genomics, University of Miami Miller School of Medicine, Miami, Florida; and §Veterans Affairs Medical Center, Miami, Florida
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Stephenson A, Kelsberg G, Neher JO, St Anna L. FPIN's Clinical Inquiries. Treatments for sciatica. Am Fam Physician 2015; 91:612-615B. [PMID: 25955735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Adam Stephenson
- University of Washington at Valley Family Medicine Residency, Renton, WA, USA
| | - Gary Kelsberg
- University of Washington at Valley Family Medicine Residency, Renton, WA, USA
| | - Jon O Neher
- University of Washington at Valley Family Medicine Residency, Renton, WA, USA
| | - Leilani St Anna
- University of Washington Health Sciences Library, Seattle, WA, USA
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Abstract
INTRODUCTION This systematic review aims to assess the effectiveness and safety of acupuncture for treating sciatica. METHODS The following nine databases will be searched from their inception to 30 October 2014: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese Biomedical Literature Database (CBM), the Chinese Medical Current Content (CMCC), the Chinese Scientific Journal Database (VIP database), the Wan-Fang Database, the China National Knowledge Infrastructure (CNKI) and Citation Information by National Institute of Informatics (CiNii). Randomised controlled trials (RCTs) of acupuncture for sciatica in English, Chinese or Japanese without restriction of publication status will be included. Two researchers will independently undertake study selection, extraction of data and assessment of study quality. Meta-analysis will be conducted after screening of studies. Data will be analysed using risk ratio for dichotomous data, and standardised mean difference or weighted mean difference for continuous data. DISSEMINATION This systematic review will be disseminated electronically through a peer-reviewed publication or conference presentations. TRIAL REGISTRATION NUMBER PROSPERO CRD42014015001.
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Affiliation(s)
- Zongshi Qin
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoxu Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Qin Yao
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Yanbing Zhai
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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de Vet HCW, Foumani M, Scholten MA, Jacobs WCH, Stiggelbout AM, Knol DL, Peul WC. Minimally important change values of a measurement instrument depend more on baseline values than on the type of intervention. J Clin Epidemiol 2014; 68:518-24. [PMID: 25544741 DOI: 10.1016/j.jclinepi.2014.07.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 07/08/2014] [Accepted: 07/13/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Multi-item questionnaires are frequently used to measure outcomes in randomized controlled trials (RCTs) in patients with sciatica. Knowing the minimaly important change (MIC) values for these instruments will facilitate interpretation of change scores. MIC values have been shown to be dependent on baseline values. The question is whether they also depend on the type of intervention. To estimate the MIC of the Roland Morris Disability Questionnaire (modified 23 item version) (RMDQ) and of intensity of leg pain measured by a Visual Analogue Scale (VAS) in patients with sciatica and to assess to what extent MIC values depend on type of intervention and on baseline values. STUDY DESIGN AND SETTING This is a secondary analysis of RCT data of the effects of early surgery vs. prolonged conservative treatment in patients with sciatica. Baseline and 8-week data were used to assess MIC of the RMDQ-23 and VAS leg pain. We used the receiver operator characteristic (ROC) method to assess the MIC. Global Perceived Recovery (rated 8 weeks after baseline) was used as anchor. Subgroups were created based on type of treatment and baseline severity. RESULTS The MIC value of the RMDQ-23 for the total group of sciatica patients was 7.5. The values were 8.1 and 6.9 for surgery and conservative treatment, respectively. For high and low baseline values, the MICs were 9.0 and 4.9, respectively, irrespective of treatment received. The MIC values of the VAS leg pain were 34.4 for the total group. For surgery and conservative treatment, the MIC values were 38.5 and 30.4, respectively, whereas for groups with high and low baseline values, MIC values of 53.5 and 17.2 were found. CONCLUSION The MIC values of the RMDQ-23 and VAS leg pain were found to be highly dependent on their baseline values, although the type of intervention appeared to influence the MIC value only slightly.
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Affiliation(s)
- Henrica C W de Vet
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7 1081 BT Amsterdam, The Netherlands.
| | - Mahrouz Foumani
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Marjolein A Scholten
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Wilco C H Jacobs
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Anne M Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Dirk L Knol
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7 1081 BT Amsterdam, The Netherlands
| | - Wilco C Peul
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; Department of Neurosurgery, Medical Center Haaglanden, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
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Lam NCK, Petersen TR, Gerstein NS, Yen T, Starr B, Mariano ER. A randomized clinical trial comparing the effectiveness of ultrasound guidance versus nerve stimulation for lateral popliteal-sciatic nerve blocks in obese patients. J Ultrasound Med 2014; 33:1057-1063. [PMID: 24866613 DOI: 10.7863/ultra.33.6.1057] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Ultrasound guidance may decrease the procedural time for many peripheral nerve blocks compared to nerve stimulation, but these studies have generally excluded obese patients. This single-blinded randomized clinical trial was designed to compare procedural times and related outcomes for ultrasound- versus nerve stimulation-guided lateral popliteal-sciatic nerve blockade specifically in obese patients. METHODS With Institutional Review Board approval and informed consent, patients with a body mass index greater than 30 kg/m(2) who were scheduled for foot/ankle surgery and desiring a peripheral nerve block were offered enrollment. Study patients were randomly assigned to receive a lateral popliteal-sciatic nerve block under either ultrasound or nerve stimulation guidance. The patient and assessor were blinded to group assignment. The primary outcome was procedural time in seconds. Secondary outcomes included number of needle redirections, procedure-related pain, patient satisfaction with the block, success rate, sensory and motor onset times, block duration, and complication rates. RESULTS Twenty-four patients were enrolled and completed the study. All patients had successful nerve blocks. The mean procedural times (SD) were 577 (57) seconds under nerve stimulation and 206 (40) seconds with ultrasound guidance (P< .001; 95% confidence interval for difference, 329-412 seconds). Patients in the ultrasound group had fewer needle redirections and less procedure-related pain, required less opioids, and were more satisfied with their block procedures. There were no statistically significant differences in other outcomes. CONCLUSIONS The results of this study show that, for obese patients undergoing lateral popliteal-sciatic nerve blocks, ultrasound guidance reduces the procedural time and procedure-related pain and increases patient satisfaction compared to nerve stimulation while providing similar block characteristics.
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Affiliation(s)
- Nicholas C K Lam
- Departments of Anesthesiology and Critical Care Medicine (N.C.K.L., T.R.P., N.S.G., T.Y., B.S.) and Anthropology (T.R.P.), University of New Mexico, Albuquerque, New Mexico USA; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA (E.R.M.); and Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA (E.R.M.)
| | - Timothy R Petersen
- Departments of Anesthesiology and Critical Care Medicine (N.C.K.L., T.R.P., N.S.G., T.Y., B.S.) and Anthropology (T.R.P.), University of New Mexico, Albuquerque, New Mexico USA; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA (E.R.M.); and Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA (E.R.M.)
| | - Neal S Gerstein
- Departments of Anesthesiology and Critical Care Medicine (N.C.K.L., T.R.P., N.S.G., T.Y., B.S.) and Anthropology (T.R.P.), University of New Mexico, Albuquerque, New Mexico USA; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA (E.R.M.); and Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA (E.R.M.)
| | - Tony Yen
- Departments of Anesthesiology and Critical Care Medicine (N.C.K.L., T.R.P., N.S.G., T.Y., B.S.) and Anthropology (T.R.P.), University of New Mexico, Albuquerque, New Mexico USA; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA (E.R.M.); and Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA (E.R.M.)
| | - Brian Starr
- Departments of Anesthesiology and Critical Care Medicine (N.C.K.L., T.R.P., N.S.G., T.Y., B.S.) and Anthropology (T.R.P.), University of New Mexico, Albuquerque, New Mexico USA; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA (E.R.M.); and Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA (E.R.M.)
| | - Edward R Mariano
- Departments of Anesthesiology and Critical Care Medicine (N.C.K.L., T.R.P., N.S.G., T.Y., B.S.) and Anthropology (T.R.P.), University of New Mexico, Albuquerque, New Mexico USA; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA (E.R.M.); and Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA (E.R.M.).
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Hofstede SN, van Bodegom-Vos L, Wentink MM, Vleggeert-Lankamp CLA, Vliet Vlieland TPM, de Mheen PJMV. Most important factors for the implementation of shared decision making in sciatica care: ranking among professionals and patients. PLoS One 2014; 9:e94176. [PMID: 24710328 PMCID: PMC3978036 DOI: 10.1371/journal.pone.0094176] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/11/2014] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Due to the increasing specialization of medical professionals, patients are treated by multiple disciplines. To ensure that delivered care is patient-centered, it is crucial that professionals and the patient together decide on treatment (shared decision making (SDM)). However, it is not known how SDM should be integrated in multidisciplinary practice. This study determines the most important factors for SDM implementation in sciatica care, as it is known that a prior inventory of factors is crucial to develop a successful implementation strategy. METHODS 246 professionals (general practitioners, physical therapists, neurologists, neurosurgeons, orthopedic surgeons) (30% response) and 155 patients (96% response) responded to an internet-based survey. Respondents ranked barriers and facilitators identified in previous interviews, on their importance using Maximum Difference Scaling. Feeding back the personal top 5 most important factors, each respondent indicated whether these factors were barriers or facilitators. Hierarchical Bayes estimation was used to estimate the relative importance (RI) of each factor. RESULTS Professionals assigned the highest importance to: quality of professional-patient relationship (RI 4.87; CI 4.75-4.99); importance of quick recovery of patient (RI 4.83; CI 4.69-4.97); and knowledge about treatment options (RI 6.64; CI 4.53-4.74), which were reported as barrier and facilitator. Professionals working in primary care had a different ranking than those working in hospital care. Patients assigned the highest importance to: correct diagnosis by professionals (barrier, RI 8.19; CI 7.99-8.38); information provision about treatment options and potential harm and benefits (RI 7.87; CI 7.65-8.08); and explanation of the professional about the care trajectory (RI 7.16; CI 6.94-7.38), which were reported as barrier and facilitator. CONCLUSIONS Knowledge, information provision and a good relationship are the most important conditions for SDM perceived by both patients and professionals. These conditions are not restricted to one specific disease or health care system, because they are mostly professional or patient dependent and require healthcare professional training.
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Affiliation(s)
- Stefanie N. Hofstede
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Manon M. Wentink
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
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el Barzouhi A, Vleggeert-Lankamp CLAM, Lycklama à Nijeholt GJ, Van der Kallen BF, van den Hout WB, Koes BW, Peul WC. Influence of low back pain and prognostic value of MRI in sciatica patients in relation to back pain. PLoS One 2014; 9:e90800. [PMID: 24637890 PMCID: PMC3956604 DOI: 10.1371/journal.pone.0090800] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 02/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with sciatica frequently complain about associated back pain. It is not known whether there are prognostic relevant differences in Magnetic Resonance Imaging (MRI) findings between sciatica patients with and without disabling back pain. METHODS The study population contained patients with sciatica who underwent a baseline MRI to assess eligibility for a randomized trial designed to compare the efficacy of early surgery with prolonged conservative care for sciatica. Two neuroradiologists and one neurosurgeon independently evaluated all MR images. The MRI readers were blinded to symptom status. The MRI findings were compared between sciatica patients with and without disabling back pain. The presence of disabling back pain at baseline was correlated with perceived recovery at one year. RESULTS Of 379 included sciatica patients, 158 (42%) had disabling back pain. Of the patients with both sciatica and disabling back pain 68% did reveal a herniated disc with nerve root compression on MRI, compared to 88% of patients with predominantly sciatica (P<0.001). The existence of disabling back pain in sciatica at baseline was negatively associated with perceived recovery at one year (Odds ratio [OR] 0.32, 95% Confidence Interval 0.18-0.56, P<0.001). Sciatica patients with disabling back pain in absence of nerve root compression on MRI at baseline reported less perceived recovery at one year compared to those with predominantly sciatica and nerve root compression on MRI (50% vs 91%, P<0.001). CONCLUSION Sciatica patients with disabling low back pain reported an unfavorable outcome at one-year follow-up compared to those with predominantly sciatica. If additionally a clear herniated disc with nerve root compression on MRI was absent, the results were even worse.
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Affiliation(s)
- Abdelilah el Barzouhi
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | - Wilbert B. van den Hout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Bart W. Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wilco C. Peul
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurosurgery, Medical Center Haaglanden, the Hague, the Netherlands
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Piccoliori G, Engl A, Gatterer D, Sessa E, in der Schmitten J, Abholz HH. Management of low back pain in general practice - is it of acceptable quality: an observational study among 25 general practices in South Tyrol (Italy). BMC Fam Pract 2013; 14:148. [PMID: 24090155 PMCID: PMC3850994 DOI: 10.1186/1471-2296-14-148] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 09/20/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND There are several guidelines dealing with the management of low back pain (LBP), but only few studies on the quality of care provided within General Practices as judged against those guidelines.The objective of this study is to analyse the management of LBP in Italian General Practice and compare it with guideline recommendations. METHODS In this observational study, all patients visiting their General Practitioners (GPs) for treatment of LBP within a 8-week period were monitored for at least four weeks with regard to symptoms and diagnostic and therapeutic interventions. Management of LBP was judged by pre-defined quality indicators based on guideline recommendations. RESULTS Twenty-five of 114 eligible GPs participated in the study, representing a total of 43,012 registered patients. Of the 475 patients complaining of LBP and monitored for four weeks, 55.8% were diagnosed as having acute lumbar pain, 13.5% chronic lumbar pain, 17.1% acute sciatica, and 12.6% chronic sciatica; 76.0% underwent no technical investigations, 21.7% underwent x-rays, 5.5% MRI and 4% CT scans; 20.4% were referred to secondary care; 93.3% of all patients received some medication. In those receiving a medication, in 88.3% it was an NSAID, in 6.3% Paracetamol, in 10.4% Paracetamol combined with Codeine, and in 9% a muscle relaxants. When physiotherapy was prescribed (17,1%), it was mostly massage. Hardly more than 50% of GPs (partially) followed locally established guidelines, while the remainder seemed not to follow guidelines at all. CONCLUSIONS Our study reveals gross deviations of GP management of LBP from current guidelines and points to two different types of deviators: those who partially follow guidelines, and those who do not follow them at all. Further research should evaluate whether these two types of deviation are best addressed by different foci of education, i.e. on knowledge versus attitudes, respectively.
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Affiliation(s)
| | - Adolf Engl
- Accademia Altoatesina di Medicina Generale (AcAMG), Bolzano, Italy
| | - Doris Gatterer
- Accademia Altoatesina di Medicina Generale (AcAMG), Bolzano, Italy
| | - Emiliano Sessa
- Statistics, Agenzia Regionale di Sanità Toscana, Florence, Italy
| | - Jürgen in der Schmitten
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Heinz-Harald Abholz
- Accademia Altoatesina di Medicina Generale (AcAMG), Bolzano, Italy
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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Pilato F, Gaudino S, Profice P, Colosimo C, Di Lazzaro V. A case of untreatable sciatica. Acta Neurol Belg 2013; 113:351-3. [PMID: 23065442 DOI: 10.1007/s13760-012-0145-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 09/29/2012] [Indexed: 11/26/2022]
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Wegner I, Widyahening IS, van Tulder MW, Blomberg SEI, de Vet HCW, Brønfort G, Bouter LM, van der Heijden GJ. Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev 2013; 2013:CD003010. [PMID: 23959683 PMCID: PMC6823219 DOI: 10.1002/14651858.cd003010.pub5] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Traction has been used to treat low-back pain (LBP), often in combination with other treatments. We included both manual and machine-delivered traction in this review. This is an update of a Cochrane review first published in 1995, and previously updated in 2006. OBJECTIVES To assess the effects of traction compared to placebo, sham traction, reference treatments and no treatment in people with LBP. SEARCH METHODS We searched the Cochrane Back Review Group Specialized Register, the Cochrane Central Register of Controlled Trials (2012, Issue 8), MEDLINE (January 2006 to August 2012), EMBASE (January 2006 to August 2012), CINAHL (January 2006 to August 2012), and reference lists of articles and personal files. The review authors are not aware of any important new randomized controlled trial (RCTs) on this topic since the date of the last search. SELECTION CRITERIA RCTs involving traction to treat acute (less than four weeks' duration), subacute (four to 12 weeks' duration) or chronic (more than 12 weeks' duration) non-specific LBP with or without sciatica. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment and data extraction. As there were insufficient data for statistical pooling, we performed a descriptive analysis. We did not find any case series that identified adverse effects, therefore we evaluated adverse effects that were reported in the included studies. MAIN RESULTS We included 32 RCTs involving 2762 participants in this review. We considered 16 trials, representing 57% of all participants, to have a low risk of bias based on the Cochrane Back Review Group's 'Risk of bias' tool.For people with mixed symptom patterns (acute, subacute and chronic LBP with and without sciatica), there was low- to moderate-quality evidence that traction may make little or no difference in pain intensity, functional status, global improvement or return to work when compared to placebo, sham traction or no treatment. Similarly, when comparing the combination of physiotherapy plus traction with physiotherapy alone or when comparing traction with other treatments, there was very-low- to moderate-quality evidence that traction may make little or no difference in pain intensity, functional status or global improvement.For people with LBP with sciatica and acute, subacute or chronic pain, there was low- to moderate-quality evidence that traction probably has no impact on pain intensity, functional status or global improvement. This was true when traction was compared with controls and other treatments, as well as when the combination of traction plus physiotherapy was compared with physiotherapy alone. No studies reported the effect of traction on return to work.For chronic LBP without sciatica, there was moderate-quality evidence that traction probably makes little or no difference in pain intensity when compared with sham treatment. No studies reported on the effect of traction on functional status, global improvement or return to work.Adverse effects were reported in seven of the 32 studies. These included increased pain, aggravation of neurological signs and subsequent surgery. Four studies reported that there were no adverse effects. The remaining studies did not mention adverse effects. AUTHORS' CONCLUSIONS These findings indicate that traction, either alone or in combination with other treatments, has little or no impact on pain intensity, functional status, global improvement and return to work among people with LBP. There is only limited-quality evidence from studies with small sample sizes and moderate to high risk of bias. The effects shown by these studies are small and are not clinically relevant. Implications for practice To date, the use of traction as treatment for non-specific LBP cannot be motivated by the best available evidence. These conclusions are applicable to both manual and mechanical traction. Implications for research Only new, large, high-quality studies may change the point estimate and its accuracy, but it should be noted that such change may not necessarily favour traction. Therefore, little priority should be given to new studies on the effect of traction treatment alone or as part of a package.
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Affiliation(s)
- Inge Wegner
- University Medical Center UtrechtDepartment of Otorhinolaryngology ‐ Head and Neck Surgery; G05.129Heidelberglaan 100UtrechtNetherlands3584 CX
| | - Indah S Widyahening
- Faculty of Medicine Universitas Indonesia ‐ Cipto Mangunkusumo HospitalCentre for Clinical Epidemiology & Evidence‐Based MedicineJakartaIndonesia
| | - Maurits W van Tulder
- VU UniversityDepartment of Health Sciences, Faculty of Earth and Life SciencesPO Box 7057Room U454AmsterdamNetherlands1007 MB
| | - Stefan EI Blomberg
- Department of Public Health and Caring SciencesFamily Medicine SectionUppsala Science ParkUppsalaSwedenSE‐751 85
| | - Henrica CW de Vet
- VU University Medical CenterDepartment of Epidemiology and Biostatistics, EMGO Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
| | - Gert Brønfort
- Northwestern Health Sciences UniversityWolfe‐Harris Center for Clinical Studies2501 West 84th StreetBloomingtonMNUSA55431
| | - Lex M Bouter
- VU UniversityDe Boelelaan 1105AmsterdamNetherlands1081 HV
| | - Geert J van der Heijden
- Academic Center for Dentistry Amsterdam (ACTA)Department of Social Dentistry5th Floor, Room 5N03Gustav Mahlerlaan 3004AmsterdamNetherlands1081LA
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