OBJECTIVE: To investigate the comparative effectiveness of nonsurgical interventions for adults with acute and subacute sciatica. DESIGN: Intervention systematic review with network meta-analysis LITERATURE SEARCH: Embase, MEDLINE, Cochrane Library, and CINAHL were searched up to June 7, 2024. STUDY SELECTION CRITERIA: Randomized controlled trials of nonsurgical interventions in adults (aged 18 years or older) with acute or subacute sciatica (less than 3 months) were included. DATA SYNTHESIS: The primary outcomes were leg pain intensity and physical function at different follow-up time points. Secondary outcomes were adverse events, mental health, and low back pain intensity. Two reviewers independently conducted screening, data extraction, and risk-of-bias assessment. Random-effects network meta-analysis was conducted, and confidence was evaluated by the Confidence in Network Meta-Analysis (CINeMA) method. RESULTS: Forty randomized controlled trials (5381 participants) were included. At short-term follow-up, compared to sham treatment/placebo, the most efficacious interventions for leg pain intensity were NSAIDs + physical therapy modalities, antibiotics, and antidepressants. Music therapy was effective for improving physical function at short-term follow-up. At long-term follow-up, steroids had a significant effect in reducing leg pain and improving physical function. No intervention showed a significant increase in adverse events compared with sham-treatment/placebo. All the evidence was based on very low confidence, primarily due to within-study bias and imprecision in effect estimates. CONCLUSIONS: Very low-confidence evidence supported some nonsurgical interventions for improving leg pain intensity and physical function in people with acute and subacute sciatica. J Orthop Sports Phys Ther 2025;55(6):1-12. Epub 25 April 2025. doi:10.2519/jospt.2025.13068.
| Discipline Area | Score |
|---|---|
| Rehab Clinician (OT/PT) |  |
Rehab Clinician (OT/PT) rater
"Sciatica....irrespective of its source"... and we wonder why there is very low-confidence evidence.
Rehab Clinician (OT/PT) rater
A very complicated paper and the statistics were hard to follow. I always question the term "usual care." What does that mean? This paper mentioned that there was a lack of consistency in the definition of "usual care." There was not much new in this paper but it did offer information that a lot of our current treatments for sciatica have very low confidence for their use. From a clinical perspective, it leaves open the possibility of trying the various modalities because what other tools do we have? The various modalities were not consistently helpful but there were no adverse events noted for the modalities.
Rehab Clinician (OT/PT) rater
Extant and established evidence (1994) already deals with this subject (neurological injury) rather well. In 1994, the Agency for Health Care Policy and Research (AHCPR) published evidence-based guidelines, "Acute Low Back Problems in Adults" (Bigos S, Bowyer 0, Braen G, et al.) Arnie /Low Back Problems in Adults. Clinical Practice Guideline, Quick Reference Guide Number. 14. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR Pub. No. 95-0643. December 1994.
Rehab Clinician (OT/PT) rater
Although the quality of the studies and the level of evidence of the findings are low, the findings suggest that a combination of conservative treatments may be effective for symptoms. Also, this review aligns with other clinical guidelines in stating that bed rest does not contribute to symptom relief.
, McMaster University