The BMJ has published a systematic review investigating the efficacy and tolerability of analgesic and adjuvant pain drugs administered in primary care for the management of pain in patients with sciatica.

Researchers searched international pharmaceutical abstracts, PsycINFO, Medline, Embase, Cochrane Central Register of Clinical Trials (CENTRAL), CINAHL, and LILACS for relevant randomised controlled trials evaluating six different classes of drugs (non-steroidal anti-inflammatory drugs, antidepressants, corticosteroids, opioid analgesics, muscle relaxants, and anticonvulsants).

Twenty three published reports met the inclusion criteria and the following findings were reported:

• The evidence to judge the efficacy of non-steroidal anti-inflammatory drugs, corticosteroids, antidepressants, anticonvulsants, muscle relaxants, and opioid analgesics ranged from moderate to low quality. Most of the pooled estimates did not favour the active treatment over placebo.

• The pooled results of two trials of corticosteroids (mean difference in overall and leg pain −12.2, 95% confidence interval −20.9 to −3.4) and a single trial of the anticonvulsant gabapentin for chronic sciatica (mean difference in overall pain relief −26.6, −38.3 to −14.9) showed some benefits but only in the short term.

• The median rate of adverse events was 17% (interquartile range 10-30%) for the active drugs and 11% (3-23%) for placebo.

Trial limitations included failure to use validated outcome measures, lack of long term follow-up, and small sample size.

The researchers concluded that as the existing evidence from clinical trials is of low quality, the efficacy and tolerability of drugs commonly prescribed for the management of sciatica in primary care is unclear.

An accompanying editorial discusses the management of pain in patients with sciatica given the poor quality of evidence.