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The Challenges of Treating Sciatica Pain in Older Adults

Abstract

Sciatica is a debilitating condition affecting approximately 25 % of the population. Typically, the patient will complain of lower limb pain that is more severe than pain in the lower back, usually accompanied by numbness and motor weakness. Most international guidelines recommend pharmacological management for the pain relief of sciatica, including paracetamol, non-steroidal anti-inflammatory drugs, opioid analgesics, anticonvulsants, and corticosteroids, among others. However, the evidence for most of these pharmacological options is scarce, and the majority of clinical trials exclude older patients. There is overall very limited information on the efficacy, safety, and tolerability of these medicines in older patients with sciatica. This review presents a critical appraisal of the existing evidence for the pharmacological treatment of sciatica, with a special focus on the older adult. The age-related changes in the health of older patients, as well as their impact on the response to pharmacological treatment, including polypharmacy, drug interactions, and drug–disease interactions, is also discussed.

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Correspondence to Manuela L. Ferreira.

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Conflict of interest

MLF declares no conflict of interest. AM is an investigator on the following three trials evaluating medicines for low back pain: PACE (ACTRN 12609000966291) was an investigator-initiated trial evaluating paracetamol for acute low back pain funded by the National Health and Medical Research Council of Australia and GlaxoSmithKline; PRECISE (ACTRN12613000530729) is an investigator-initiated trial evaluating pregabalin for sciatica funded by the National Health and Medical Research Council of Australia and Pfizer; OPAL (ACTRN12615000775516) is an investigator-initiated trial evaluating an opioid analgesic for acute low back pain funded by the National Health and Medical Research Council of Australia.

Funding

No sources of funding were used to conduct this study or prepare this manuscript. MLF holds a Sydney Medical Foundation Fellowship. AM is the Program Director for the Australian National Health and Medical Research Council Centre for Research Excellence in Medicines and Ageing.

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Ferreira, M.L., McLachlan, A. The Challenges of Treating Sciatica Pain in Older Adults. Drugs Aging 33, 779–785 (2016). https://doi.org/10.1007/s40266-016-0404-z

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Keywords

  • Gabapentin
  • Pregabalin
  • Opioid Analgesic
  • Spinal Pain
  • Pharmacological Trial