Does Gender Make a Difference With Sciatica?Lumbar disc herniation can cause both low back pain and sciatica (pain down the leg). Pressure on the spinal nerve root and chemicals released by the damaged disc cause this type of aching pain often with numbness and tingling. It's a common disorder resulting in hospitalization, work absenteeism, and disability.
Most of the time, sciatica resolves (goes away) on its own. The symptoms usually fade away over a period of six to eight weeks. In some cases, recovery is much slower or doesn't happen at all. Chronic pain of this type seems to affect women more than men. And women's outcomes are reportedly worse over time.
If this is true, there may be ways to direct treatment based on gender. Studies show a general trend for women to report more pain in more parts of the body more often than men. In this study, the influence of gender and other predictive factors on sciatica are explored.
Patients involved in a study called the Sciatica Trial were included. All had severe sciatica caused by disc herniation. Pain was incapacitating and lasted six to 12 weeks. Patients were randomly placed in one of two groups. The first group had a long period of conservative (nonoperative) care. Some of the patients in this group had surgery late in the treatment.
Patients in the conservative care group were assured that the pain could subside in time -- even if the intensity was high at the start. Pain medication was used when needed. Patients were advised to keep active according to currently accepted treatment guidelines.
Anyone who was afraid to move in order to avoid pain or further injury was sent to physical therapy to overcome this fear avoidance behavior (FAB). Anyone who did not respond to nonoperative care was offered surgery (microdiscectomy) after six months.
The second group had surgery early, often within two weeks of the start of the sciatica. Surgery was cancelled if the symptoms went away suddenly before the operation. The surgical procedure performed was a discectomy. This means that loose fragments of disc were removed from inside the disc space. Follow-up physical therapy was provided at home. A standard exercise program was prescribed.
Everyone was followed at regular intervals up to one year. Pain, time to recovery, function, disability, and return to work were used as outcome measures. Overall, women had a slower rate of recovery. Women were also more likely to have an unsuccessful recovery at the end of a year. Some women were completely recovered but others were much worse.
The effect of many other factors was analyzed. Besides gender, age, duration of sciatica, type of job, marital or partner status, and smoking habits were recorded. The men and women weren't different at baseline except in one area. Women had worse sciatica at the start.
There was one other predictive factor of recovery. Patients with a positive Bragard's sign were more likely to have a slower speed of recovery. The Bragard's sign is a nerve stretch test. It is positive for abnormal nerve stretch if dorsiflexion of the foot makes the leg pain worse while raising the leg straight. Dorsiflexion is a flexion movement of the foot and ankle with the toes moving toward the face.
And there was one other important finding. Men were more likely to respond with a good result to early surgery. Women in the surgical group did seem to recover faster after early surgery compared to women in the conservative care group. Comparing men and women who had an unsatisfactory result, women also had higher pain intensity and greater disability.
At the end of the article, the authors went back to discuss further the finding that women have greater pain severity and disability at the time of diagnosis. This is consistent with other studies that show women are less likely to seek medical help until they are much worse than men. Female patients are less willing to agree to surgery so they delay medical treatment longer than men.
There isn't enough information to really come up with a treatment plan that is based on gender. Based on current findings, it makes sense for the physician to make note of each patient's gender when planning treatment. When gender-specific factors become more evident, then targeted treatment may become a reality.
Wilco C. Peul, et al. Influence of Gender and Other Prognostic Factors on Outcome of Sciatica. In Pain. August 2008. Vol. 138. No. 1. Pp. 180-191.
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