Abstract
BackgroundPatients with back pain radiating to the leg(s) report worse symptoms and poorer recovery than those with back pain alone. Robust evidence regarding their epidemiological profile is lacking from primary care, the setting where most of these patients will present and be managed. Our objective was to describe the characteristics of patients with back and leg pain, including sciatica, seeking treatment in primary care.MethodsAdults visiting their general practitioner with back and leg pain, of any duration and severity, were invited to participate. Participants completed questionnaires, underwent clinical assessments and received MRI scans. Characteristics of the sample are described, and differences between patients diagnosed with referred leg pain and those with sciatica are analysed.ResultsSix hundred nine patients participated; 62.6 % were female, mean (SD) age 50.2 (13.9). 67.5 % reported pain below the knee, 60.7 % were in paid employment with 39.7 % reporting time off work. Mean disability (RMDQ) was 12.7 (5.7) and mean pain intensity was 5.6 (2.2) and 5.2 (2.4) for back and leg respectively. Mean sciatica bothersomeness index (SBI) was 14.9 (5.1). Three quarters (74.2 %) were clinically diagnosed as having sciatica. In the sciatica group, leg pain intensity, neuropathic pain, pain below the knee, leg pain worse than back pain, SBI and positive MRI findings were significantly higher as compared to patients with referred leg pain.ConclusionsThis primary care cohort reported high levels of disability and pain. This is the first epidemiological study of unselected primary care patients seeking healthcare for back and leg pain. Follow-up of this cohort will investigate the prognostic value of their baseline characteristics. This new information will contribute to our understanding of the characteristics and clinical features of this population, and will underpin future research aimed at defining prognostic subgroups to enable better targeting of health care provision.
Highlights
Patients with back pain radiating to the leg(s) report worse symptoms and poorer recovery than those with back pain alone
All four cases presented at baseline assessment as sciatic pain, and one case of inflammatory arthritis presented as referred leg pain
In this paper we describe the characteristics of 609 primary care patients seeking care for symptoms of back and leg pain including sciatica
Summary
Patients with back pain radiating to the leg(s) report worse symptoms and poorer recovery than those with back pain alone Robust evidence regarding their epidemiological profile is lacking from primary care, the setting where most of these patients will present and be managed. Approximately 60 % of patients presenting with low back pain (LBP) report pain in the leg(s) [1]. Leg pain associated with LBP is generally considered to be either referred or radicular pain The latter is commonly labelled sciatica and is often characterised by pain radiating to below the knee, into the foot and toes, and may be accompanied by objective findings of nerve root entrapment such as sensory deficits, reflex changes or muscle weakness [2]. There is an inherent contradiction in the guidelines as despite the call for accurate and early diagnosis of low back related leg pain, the recommendations for initial treatment of patients with leg pain, including sciatica, appear to be similar to those for non-specific LBP
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