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Sciatica

Prognostic Implications of the Quebec Task Force Classification

By |April 9, 2018|Low Back Pain, Sciatica|

Prognostic Implications of the Quebec Task Force Classification of Back-related Leg Pain:
An Analysis of Longitudinal Routine Clinical Data

The Chiro.Org Blog

SOURCE:   BMC Musculoskelet Disord. 2013 (May 24); 14: 171

Alice Kongsted, Peter Kent, Tue Secher Jensen, Hanne Albert and Claus Manniche

Research Department,
The Spine Centre of Southern Denmark,
Middelfart, Hospital Lillebaelt,
Institute of Regional Health Services Research,
University of Southern Denmark,
Middelfart, Denmark

BACKGROUND:   Low back pain (LBP) patients with related leg pain have a more severe profile than those with local LBP and a worse prognosis. Pain location above or below the knee and the presence of neurological signs differentiate patients with different profiles, but knowledge about the prognostic value of these subgroups is sparse. The objectives of this study were (1) to investigate whether subgroups consisting of patients with Local LBP only, LBP + leg pain above the knee, LBP + leg pain below the knee, and LBP + leg pain and neurological signs had different prognoses, and (2) to determine if this was explained by measured baseline factors.

METHODS:   Routine clinical data were collected during the first visit to an outpatient department and follow-ups were performed after 3 and 12 months. Patients were divided into the four subgroups and associations between subgroups and the outcomes of activity limitation, global perceived effect (GPE) after 3 months, and sick leave after 3 months were tested by means of generalised estimating equations. Models were univariate (I), adjusted for duration (II), and adjusted for all baseline differences (III).

RESULTS:   A total of 1,752 patients were included, with a 76% 3-month and 70% 12-month follow-up. Subgroups were associated with activity limitation in all models (p < 0.001). Local LBP had the least and LBP + neurological signs the most severe limitations at all time-points, although patients with neurological signs improved the most. Associations with GPE after 3 months were only significant in Model I. Subgroups were associated with sick leave after 3 months in model I and II, with sick leave being most frequent in the subgroup with neurological signs. No significant differences were found in any pairwise comparisons of patients with leg pain above or below the knee.

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Chiropractic and Sciatica Page and the:

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Spinal Manipulation and Home Exercise With Advice

By |August 28, 2017|Low Back Pain, Sciatica|

Spinal Manipulation and Home Exercise With Advice for Subacute and Chronic
Back-related Leg Pain: A Trial With Adaptive Allocation

The Chiro.Org Blog

SOURCE:   Annals of Internal Medicine 2014 (Sep 16); 161 (6): 381—391

Gert Bronfort, DC, PhD; Maria A. Hondras, DC, MPH;
Craig A. Schulz, DC, MS; Roni L. Evans, DC, PhD;
Cynthia R. Long, PhD; and Richard Grimm, MD, PhD

University of Minnesota,
Northwestern Health Sciences University, and
Berman Center for Outcomes and Clinical Research at
the Minneapolis Medical Research Foundation,
Minneapolis, Minnesota, and
Palmer Center for Chiropractic Research,
Davenport, Iowa.

BACKGROUND:   Back-related leg pain (BRLP) is often disabling and costly, and there is a paucity of research to guide its management.

OBJECTIVE:   To determine whether spinal manipulative therapy (SMT) plus home exercise and advice (HEA) compared with HEA alone reduces leg pain in the short and long term in adults with BRLP.

DESIGN:   Controlled pragmatic trial with allocation by minimization conducted from 2007 to 2011.
(ClinicalTrials.gov: NCT00494065).

SETTING:   2 research centers (Minnesota and Iowa).

PATIENTS:   Persons aged 21 years or older with BRLP for least 4 weeks.

INTERVENTION:   12 weeks of SMT plus HEA or HEA alone.

MEASUREMENTS:   The primary outcome was patient-rated BRLP at 12 and 52 weeks. Secondary outcomes were self-reported low back pain, disability, global improvement, satisfaction, medication use, and general health status at 12 and 52 weeks. Blinded objective tests were done at 12 weeks.

RESULTS:   Of the 192 enrolled patients, 191 (99%) provided follow-up data at 12 weeks and 179 (93%) at 52 weeks. For leg pain, SMT plus HEA had a clinically important advantage over home exercise and advice (HEA) (difference, 10 percentage points [95% CI, 2 to 19]; P=0.008) at 12 weeks but not at 52 weeks (difference, 7 percentage points [CI, -2 to 15]; P=0.146). Nearly all secondary outcomes improved more with SMT plus HEA at 12 weeks, but only global improvement, satisfaction, and medication use had sustained improvements at 52 weeks. No serious treatment-related adverse events or deaths occurred.

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Leg Pain Location and Neurological Signs Relate to Outcomes in Primary Care Patients with Low Back Pain

By |April 6, 2017|Clinical Decision Rule, Sciatica|

Leg Pain Location and Neurological Signs Relate to Outcomes in Primary Care Patients with Low Back Pain

The Chiro.Org Blog

SOURCE:   BMC Musculoskelet Disord. 2017 (Mar 31); 18 (1): 133

Lisbeth Hartvigsen, Lise Hestbaek, Charlotte Lebouef-Yde,
Werner Vach and Alice Kongsted

Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark

BACKGROUND:   Low back pain (LBP) patients with related leg pain and signs of nerve root involvement are considered to have a worse prognosis than patients with LBP alone. However, it is unclear whether leg pain location above or below the knee and the presence of neurological signs are important in primary care patients. The objectives of this study were to explore whether the four Quebec Task Force categories (QTFC) based on the location of pain and on neurological signs have different characteristics at the time of care seeking, whether these QTFC are associated with outcome, and if so whether there is an obvious ranking of the four QTFC on the severity of outcomes.

METHOD:   Adult patients seeking care for LBP in chiropractic or general practice were classified into the four QTFC based on self-reported information and clinical findings. Analyses were performed to test the associations between the QTFC and baseline characteristics as well as the outcomes global perceived effect and activity limitation after 2 weeks, 3 months, and 1 year and also 1-year trajectories of LBP intensity.

RESULTS:   The study comprised 1,271 patients; 947 from chiropractic practice and 324 from general practice. The QTFC at presentation were statistically significantly associated with most of the baseline characteristics, with activity limitation at all follow-up time points, with global perceived effect at 2 weeks but not 3 months and 1 year, and with trajectories of LBP. Severity of outcomes in the QTFC increased from LBP alone, across LBP with leg pain above the knee and below the knee to LBP with nerve root involvement. However, the variation within the categories was considerable.

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Pain Location Matters: The Impact of Leg Pain on Health Care Use, Work Disability and Quality of Life in Patients with Low Back Pain

By |April 5, 2017|Low Back Pain, Outcome Assessment, Sciatica|

Pain Location Matters: The Impact of Leg Pain on Health Care Use, Work Disability and Quality of Life in Patients with Low Back Pain

The Chiro.Org Blog

SOURCE:   Eur Spine J. 2015 (Mar); 24 (3): 444–451

Samantha L. Hider, David G. T. Whitehurst,
Elaine Thomas, Nadine E. Foster

Arthritis Research UK Primary Care Centre,
Keele University, Keele,
Staffordshire, ST5 5BG, UK.

PURPOSE:   In low back pain (LBP) patients, those with radiating leg pain or sciatica have poorer pain and disability outcomes. Few studies have assessed the effect of leg pain on health care use and quality of life.

METHODS:   Prospective cohort study of 1,581 UK LBP primary care consulters. Back pain, employment, health care utilisation, and quality of life (EQ-5D) data were collected at baseline, 6 and 12 months. At baseline, patients were classified as reporting

(1)   LBP only

(2)   LBP and leg pain above the knee only (LBP + AK) or

(3)   LBP and leg pain extending below the knee (LBP + BK).

RESULTS:   Self-reported leg pain was common; at baseline 645 (41%) reported LBP only, 392 (25%) reported LBP + AK and 544 (34%) reported LBP + BK. Patients with LBP + BK, compared to those with LBP only, were significantly more likely to be unemployed, take time off work, consult their family doctor, receive physical therapy, or be referred to other health care practitioners. There were statistically significant decrements in EQ-5D scores for LBP + AK compared to LBP only, and for LBP + BK compared to LBP + AK (p ≤ 0.05 for all comparisons).

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Epidural Corticosteroids for Sciatica

By |June 10, 2014|Epidural Steroid Injections, Low Back Pain, Sciatica|

Epidural Corticosteroids for Sciatica

The Chiro.Org Blog

SOURCE:   Dynamic Chiropractic

By Deborah Pate, DC, DACBR

Use of epidural steroid injections has increased dramatically in recent years, despite the fact that studies have failed to demonstrate evidence this procedure is clinically helpful (while other studies suggest it may actually be dangerous).

Considering that lack of evidence – not to mention the terrible 2012 outbreak of fungal meningitis / infections [see sidebar] caused by contaminated vials used for epidural corticosteroid injections – it is prudent at least to take a critical look at this procedure, particularly as it relates to conditions doctors of chiropractic treat.

Steroid Injections for Sciatica: Small, Short-Term Relief Only

In a recent meta-analysis of 23 randomized trials involving more than 2,000 patients in which epidural steroid injections were compared with placebo for sciatica, epidural steroid injections produced small, statistically insignificant short-term improvements in leg pain and disability (but not less back pain) compared to placebo. This improvement also was only over a short period of time – two weeks to three months. Beyond 12 months, there was no significant difference between groups. [1]

Side Effects Including Skeletal Deterioration, Fracture Risk

Besides infection, there are other side effects associated with epidural steroid injections: bleeding, nerve damage and dural puncture. Then there are side effects associated with the steroid medication, which include the following: a transient decrease in immunity, high blood sugar, stomach ulcers, avascular necrosis (mainly in the hip joint), cataracts and increased risk of fracture.

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