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Nonsteroidal Anti-inflammatory Drugs for Sciatica: An Updated Cochrane Review

Rasmussen-Barr, Eva PhD; Held, Ulrike PhD; Grooten, Wilhelmus J.A. PhD; Roelofs, Pepijn D.D.M. PhD; Koes, Bart W. PhD; van Tulder, Maurits W. PhD; Wertli, Maria M. MD, PhD

doi: 10.1097/BRS.0000000000002092
Cochrane Collaboration

Study Design. Systematic review and meta-analysis.

Objective. To determine the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) on pain reduction, overall improvement, and reported adverse effects in people with sciatica.

Summary of Background Data. NSAIDs are one of the most frequently prescribed drugs for sciatica.

Methods. We updated a 2008 Cochrane Review through June 2015. Randomized controlled trials that compared NSAIDs with placebo, with other NSAIDs, or with other medication were included. Outcomes included pain using mean difference (MD, 95% confidence intervals [95% CI]). For global improvement and adverse effects risk ratios (RR, 95% CI) were used. We assessed level of evidence using the Grades of Recommendation, Assessment, Development and Evaluation approach.

Results. Ten trials were included (N = 1651). Nine out of 10 trials were assessed at high risk of bias. For pain reduction (visual analog scale, 0 to 100) NSAIDs were no more effective than placebo (MD −4.56, 95% CI −11.11 to 1.99, quality of evidence: very low). For global improvement NSAIDs were more effective than placebo (RR 1.14 [95% CI 1.03 to 1.27], low quality of evidence). One trial reported the effect of NSAIDs on disability with very low-quality evidence that NSAIDs are no more effective than placebo. There was low-quality evidence that the risk for adverse effects is higher for NSAID than placebo (RR 1.40, 95% CI 1.02 to 1.93).

Conclusion. Our findings show very low-quality evidence that the efficacy of NSAIDs for pain reduction is comparable with that of placebo, low-quality evidence that NSAIDs is better than placebo for global improvement and low-quality evidence for higher risk of adverse effects using NSAIDs compared with placebo. The findings must be interpreted with caution, due to small study samples, inconsistent results, and a high risk of bias in the included trials.

Level of Evidence: 1

*The Institute of Environmental Medicine, Department of Cardiovascular Epidemiology, Karolinska Institutet, Stockholm, Sweden

Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden

Horten Centre for Patient Oriented Research, University of Zurich, Zurich, Switzerland

§Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands

Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands

||Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands.

Address correspondence and reprint requests to Eva Rasmussen-Barr, PhD, The Institute of Environmental Medicine, Department of Cardiovascular Epidemiology, Karolinska Institutet, Box 210, SE-17177 Stockholm, Sweden; E-mail: eva.rasmussen.barr@ki.se

Received 3 January, 2017

Accepted 4 January, 2017

This review is adapted from the Cochrane Review; “Rasmussen-Barr E, Held U, Grooten, JWA, et al. Nonsteroidal anti-inflammatory drugs for sciatica. Cochrane Database Syst Rev 2016;(10):Art. no.: CD012382. doi: 10.1002/1465185”. Copyright Cochrane Library, reproduced with permission.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants, travel/accommodations/meeting expenses.

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