The Efficacy of Systematic Active Conservative Treatment for Patients With Severe Sciatica

Abstract

Prospective single-blind, randomized, clinical, controlled trial. To evaluate the efficacy of active conservative treatment and to compare 2 active conservative treatment programs for patients with severe sciatica. Reviews have demonstrated little or no efficacy for passive conservative treatment modalities in patients suffering from sciatica. The results for surgery are conflicting. Cohort studies have shown excellent results for active treatment modalities in patients with sciatica. One hundred eighty-one consecutive patients with radicular pain below the knee were examined at the baseline, at 8 weeks, and at 1 year after the treatment. Participants were randomized into 2 groups: (1) symptom-guided exercises + information + advice to stay active and (2) sham exercises + information + advice to stay active. Symptom-guided exercises consisted of a variety of back-related exercises given in accordance with a written algorithm in which symptoms or response to exercises determined the exercises given (http://www.sygehuslillebaelt.dk/wm345075, click exercises). Sham exercises were optional, designed to increase general blood circulation, and had no targeted effect on the back. The information was comprehensive and included anatomy, pathogenesis, and how discs heal without surgery. The advice included encouragement to stay as active as possible but to reduce activity if leg pain increased. The use of medication was optional, but only paracetamol and nonsteroidal anti-inflammatory drugs were recommended. A mean of 4.8 treatment sessions were provided. All patients experienced statistically significant and clinically important improvements in global assessment, functional status, pain, vocational status, and clinical findings. The symptom-guided exercise group improved significantly more than the sham exercise group in most outcomes. Active conservative treatment was effective for patients who had symptoms and clinical findings that would normally qualify them for surgery. Although participating patients had greater faith in the sham exercises before treatment, the symptom-guided exercises were superior for most outcomes.