Predicting Treatment Results for SciaticaThere's a wide range of patient responses to treatment for low back pain
(LBP). Some people get better while others develop chronic pain. Scientists
are trying to find out why this happens. Studies show that psychosocial
factors may predict the development of chronic LBP. These same factors may also predict the results or outcomes of treatment.
In this study, researchers from Johns Hopkins School of Medicine look for
predictors of pain-related outcomes after treatment for sciatica (leg
pain and numbness). Specifically, they looked to see if psychologic distress
(depression, anxiety) could predict pain and disability.
The goal is to find ways to screen patients ahead of time to identify these
predictive factors. This might help doctors choose the best treatment for each patient.
All patients in the study had a disc herniation causing the sciatica. Each patient took a survey before and after treatment to measure levels of distress. Treatment was different for each patient and included both nonoperative care and surgery.
The authors expected to find that higher levels of distress before treatment
would be linked with greater pain and disability. They did find that psychologic distress is a general risk factor for all patients. The greater
the distress, the more pain and disability present after treatment. This was true for all kinds of treatment and included workers' compensation patients.
The authors say the results of this study do not suggest patients with depression or anxiety should not be treated. There's a reason anxiety and
depression strongly predict pain and disability as much as three years after
treatment. It may be because these patients have poor coping strategies but
that's just a guess. Future studies should take a look at this factor.
Robert R. Edwards, et al. Symptoms of Distress as Prospective Predictors of Pain-Related Sciatica Treatment Outcomes. In Pain.July 2007. Vol. 130. No. 1-2. Pp. 47-55.
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