A review of the current state of knowledge on Sciatica for family physicians. Diagnosis and potential treatments
DOI:
https://doi.org/10.12775/QS.2025.41.59948Keywords
sciatica, lower back pain, treatment, diagnosing, family physician, general practitionerAbstract
Sciatica or lower back pain (LBP) with sciatic radiation is one of the most common problems in primary care. Patients with such ailment vary in age and general condition of health, with average age of patient reporting such symptoms successively lowering. The aim of this article is to broaden the knowledge of medical practitioners on diagnosis, management and potential treatments of lower back pain with sciatic radiation by reviewing available information on various aspects of diagnosing, managing and means of treatment od sciatica. Updated information on diagnosing and treating sciatica may prove crucial for family physicians or general practitioners (GP) due to ever increasing number of patients.
References
1. Wong, C.K.; Mak, R.Y.; Kwok, T.S.; Tsang, J.S.; Leung, M.Y.; Funabashi, M.; Macedo, L.G.; Dennett, L.; Wong, A.Y. Prevalence, Incidence, and Factors Associated With Non-Specific Chronic Low Back Pain in Community-Dwelling Older Adults Aged 60 Years and Older: A Systematic Review and Meta-Analysis. J. Pain 2022, 23, 509–534, doi:10.1016/j.jpain.2021.07.012.
2. Alexander, C.E.; Weisbrod, L.J.; Varacallo, M. Lumbosacral Radiculopathy. In StatPearls; StatPearls Publishing: Treasure Island (FL), 2024.
3. Oliveira, C.B.; Amorim, H.E.; Coombs, D.M.; Richards, B.; Reedyk, M.; Maher, C.G.; Machado, G.C. Emergency Department Interventions for Adult Patients with Low Back Pain: A Systematic Review of Randomised Controlled Trials. Emerg. Med. J. EMJ 2021, 38, 59–68, doi:10.1136/emermed-2020-209588.
4. A Systematic Review of the Global Prevalence of Low Back Pain., doi:10.1002/art.34347.
5. Global, Regional, and National Incidence, Prevalence, and Years Lived with Disability for 354 Diseases and Injuries for 195 Countries and Territories, 1990–2017: A Systematic Analysis for the Global Burden of Disease Study 2017. Lancet Lond. Engl. 2018, 392, 1789–1858, doi:10.1016/S0140-6736(18)32279-7.
6. Interna Szczeklika 2024; Szczeklik, A., Ed.; Medycyna Praktyczna: Kraków, 2024; ISBN 978-83-7430-717-8.
7. Galliker, G.; Scherer, D.E.; Trippolini, M.A.; Rasmussen-Barr, E.; LoMartire, R.; Wertli, M.M. Low Back Pain in the Emergency Department: Prevalence of Serious Spinal Pathologies and Diagnostic Accuracy of Red Flags. Am. J. Med. 2020, 133, 60-72.e14, doi:10.1016/j.amjmed.2019.06.005.
8. Stubbs, P.W.; Verhagen, A.P. Estimating Prevalence of Serious Spinal Pathology in Patients Presenting to the Emergency Department With Low Back Pain: Misrepresentation of Prospective Studies. Am. J. Med. 2020, 133, e613, doi:10.1016/j.amjmed.2020.01.011.
9. Koumtouzoua, S.; Higgins, S. Evaluating and Managing the Patient with Back Pain. Med. Clin. North Am. 2021, 105, 1–17, doi:10.1016/j.mcna.2020.08.014.
10. Schwill, C. [Back pain in the primary care setting : Specific back pain]. Internist 2021, 62, 34–46, doi:10.1007/s00108-020-00919-5.
11. Urrutia, J.; Besa, P.; Meissner-Haecker, A.; Gonzalez, R.; Gonzalez, J. Management of Patients with Low Back Pain in the Emergency Department: Is It Feasible to Follow Evidence-Based Recommendations? Emerg. Med. Australas. EMA 2020, 32, 1001–1007, doi:10.1111/1742-6723.13544.
12. Luites, J.W.H.; Kuijer, P.P.F.M.; Hulshof, C.T.J.; Kok, R.; Langendam, M.W.; Oosterhuis, T.; Anema, J.R.; Lapré-Utama, V.P.; Everaert, C.P.J.; Wind, H.; et al. The Dutch Multidisciplinary Occupational Health Guideline to Enhance Work Participation Among Low Back Pain and Lumbosacral Radicular Syndrome Patients. J. Occup. Rehabil. 2022, 32, 337–352, doi:10.1007/s10926-021-09993-4.
13. Machado, G.C.; Ghinea, N.; Rogan, E.; Day, R.O.; Maher, C.G. Emergency Department Care for Low Back Pain: Should We Adopt Recommendations from Primary Care Guidelines? Emerg. Med. Australas. EMA 2020, 32, 890–892, doi:10.1111/1742-6723.13593.
14. Luites, J.W.H.; Kuijer, P.P.F.M.; Hulshof, C.T.J.; Kok, R.; Langendam, M.W.; Oosterhuis, T.; Anema, J.R.; Lapré-Utama, V.P.; Everaert, C.P.J.; Wind, H.; et al. The Dutch Multidisciplinary Occupational Health Guideline to Enhance Work Participation Among Low Back Pain and Lumbosacral Radicular Syndrome Patients. J. Occup. Rehabil. 2022, 32, 337–352, doi:10.1007/s10926-021-09993-4.
15. Aguilar-Shea, A.L.; Gallardo-Mayo, C.; Sanz-González, R.; Paredes, I. Sciatica. Management for Family Physicians. J. Fam. Med. Prim. Care 2022, 11, 4174–4179, doi:10.4103/jfmpc.jfmpc_1061_21.
16. Zaina, F.; Côté, P.; Cancelliere, C.; Di Felice, F.; Donzelli, S.; Rauch, A.; Verville, L.; Negrini, S.; Nordin, M. A Systematic Review of Clinical Practice Guidelines for Persons With Non-Specific Low Back Pain With and Without Radiculopathy: Identification of Best Evidence for Rehabilitation to Develop the WHO’s Package of Interventions for Rehabilitation. Arch. Phys. Med. Rehabil. 2023, 104, 1913–1927, doi:10.1016/j.apmr.2023.02.022.
17. Machado, G.C.; Ghinea, N.; Rogan, E.; Day, R.O.; Maher, C.G. Emergency Department Care for Low Back Pain: Should We Adopt Recommendations from Primary Care Guidelines? Emerg. Med. Australas. EMA 2020, 32, 890–892, doi:10.1111/1742-6723.13593.
18. Wang, K.Y.; Yen, C.J.; Chen, M.; Variyam, D.; Acosta, T.U.; Reed, B.; Wintermark, M.; Lincoln, C.M. Reducing Inappropriate Lumbar Spine MRI for Low Back Pain: Radiology Support, Communication and Alignment Network. J. Am. Coll. Radiol. JACR 2018, 15, 116–122, doi:10.1016/j.jacr.2017.08.005.
19. Baxter, G.D.; Chapple, C.; Ellis, R.; Hill, J.; Liu, L.; Mani, R.; Reid, D.; Stokes, T.; Tumilty, S. Six Things You Need to Know about Low Back Pain. J. Prim. Health Care 2020, 12, 195–198, doi:10.1071/HC19117.
20. Tacy, R.M.; Donaworth, S.; Ballman, K. Application of Primary Care Guideline for Chronic Low Back Pain in the Emergency Department. Adv. Emerg. Nurs. J. 2017, 39, 123–140, doi:10.1097/TME.0000000000000144.
21. Tahvonen, P.; Oikarinen, H.; Niinimäki, J.; Liukkonen, E.; Mattila, S.; Tervonen, O. Justification and Active Guideline Implementation for Spine Radiography Referrals in Primary Care. Acta Radiol. Stockh. Swed. 1987 2017, 58, 586–592, doi:10.1177/0284185116661879.
22. Siddiq, M.A.B.; Clegg, D.; Hasan, S.A.; Rasker, J.J. Extra-Spinal Sciatica and Sciatica Mimics: A Scoping Review. Korean J. Pain 2020, 33, 305–317, doi:10.3344/kjp.2020.33.4.305.
23. Balasubramanya, R.; Selvarajan, S.K. Lumbar Spine Imaging. In StatPearls; StatPearls Publishing: Treasure Island (FL), 2024.
24. Lavi, E.S.; Pal, A.; Bleicher, D.; Kang, K.; Sidani, C. MR Imaging of the Spine: Urgent and Emergent Indications. Semin. Ultrasound. CT MR 2018, 39, 551–569, doi:10.1053/j.sult.2018.10.006.
25. Debnath, U.K. Lumbar Spondylolysis - Current Concepts Review. J. Clin. Orthop. Trauma 2021, 21, 101535, doi:10.1016/j.jcot.2021.101535.
26. Zafar, H.M.; Ip, I.K.; Mills, A.M.; Raja, A.S.; Langlotz, C.P.; Khorasani, R. Effect of Clinical Decision Support–Generated Report Cards Versus Real-Time Alerts on Primary Care Provider Guideline Adherence for Low Back Pain Outpatient Lumbar Spine MRI Orders. Am. J. Roentgenol. 2019, 212, 386–394, doi:10.2214/AJR.18.19780.
27. Franco, D.; Mahtabfar, A.; Hines, K.; Sabourin, V.; Stefanelli, A.; Harrop, J. Neurosurgical Evaluation for Patients with Chronic Lower Back Pain. Curr. Pain Headache Rep. 2020, 24, 58, doi:10.1007/s11916-020-00894-4.
28. Soares, L.O.; Ferreira, G.E.; Costa, L.O.P.; Nogueira, L.C.; Meziat-Filho, N.; Reis, F.J.J. Meditation for Adults with Non-Specific Low Back Pain: A Systematic Review and Meta-Analysis. Scand. J. Pain 2022, 22, 26–39, doi:10.1515/sjpain-2021-0096.
29. Koumtouzoua, S.; Higgins, S. Evaluating and Managing the Patient with Back Pain. Med. Clin. North Am. 2021, 105, 1–17, doi:10.1016/j.mcna.2020.08.014.
30. Kim, H.S.; Ciolino, J.D.; Lancki, N.; Strickland, K.J.; Pinto, D.; Stankiewicz, C.; Courtney, D.M.; Lambert, B.L.; McCarthy, D.M. A Prospective Observational Study of Emergency Department–Initiated Physical Therapy for Acute Low Back Pain. Phys. Ther. 2020, 101, pzaa219, doi:10.1093/ptj/pzaa219.
31. Stochkendahl, M.J.; Kjaer, P.; Hartvigsen, J.; Kongsted, A.; Aaboe, J.; Andersen, M.; Andersen, M.Ø.; Fournier, G.; Højgaard, B.; Jensen, M.B.; et al. National Clinical Guidelines for Non-Surgical Treatment of Patients with Recent Onset Low Back Pain or Lumbar Radiculopathy. Eur. Spine J. 2018, 27, 60–75, doi:10.1007/s00586-017-5099-2.
32. Quentin, C.; Bagheri, R.; Ugbolue, U.C.; Coudeyre, E.; Pélissier, C.; Descatha, A.; Menini, T.; Bouillon-Minois, J.-B.; Dutheil, F. Effect of Home Exercise Training in Patients with Nonspecific Low-Back Pain: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public. Health 2021, 18, 8430, doi:10.3390/ijerph18168430.
33. Giménez-Campos, M.S.; Pimenta-Fermisson-Ramos, P.; Díaz-Cambronero, J.I.; Carbonell-Sanchís, R.; López-Briz, E.; Ruíz-García, V. A Systematic Review and Meta-Analysis of the Effectiveness and Adverse Events of Gabapentin and Pregabalin for Sciatica Pain. Aten. Primaria 2022, 54, 102144, doi:10.1016/j.aprim.2021.102144.
34. Gianola, S.; Bargeri, S.; Del Castillo, G.; Corbetta, D.; Turolla, A.; Andreano, A.; Moja, L.; Castellini, G. Effectiveness of Treatments for Acute and Subacute Mechanical Non-Specific Low Back Pain: A Systematic Review with Network Meta-Analysis. Br. J. Sports Med. 2022, 56, 41–50, doi:10.1136/bjsports-2020-103596.
35. Hayden, J.A.; Ellis, J.; Asbridge, M.; Ogilvie, R.; Merdad, R.; Grant, D.A.G.; Stewart, S.A.; Campbell, S. Prolonged Opioid Use among Opioid-Naive Individuals after Prescription for Nonspecific Low Back Pain in the Emergency Department. Pain 2021, 162, 740–748, doi:10.1097/j.pain.0000000000002075.
36. Liu, C.; Ferreira, G.E.; Abdel Shaheed, C.; Chen, Q.; Harris, I.A.; Bailey, C.S.; Peul, W.C.; Koes, B.; Lin, C.-W.C. Surgical versus Non-Surgical Treatment for Sciatica: Systematic Review and Meta-Analysis of Randomised Controlled Trials. The BMJ 2023, 381, e070730, doi:10.1136/bmj-2022-070730.
37. Peckham, M.E.; Hutchins, T.A.; Shah, L.M. Conventional Image-Guided Procedures for Painful Spine. Neuroimaging Clin. N. Am. 2019, 29, 539–551, doi:10.1016/j.nic.2019.07.004.
38. Aguilar-Shea, A.L.; Gallardo-Mayo, C.; Sanz-González, R.; Paredes, I. Sciatica. Management for Family Physicians. J. Fam. Med. Prim. Care 2022, 11, 4174–4179, doi:10.4103/jfmpc.jfmpc_1061_21.
39. Seo, J.-H.; Baik, S.-W.; Ko, M.-H.; Won, Y.-H.; Park, S.-H.; Oh, S.W.; Kim, G.-W. Comparing the Efficacy of Combined Treatment with Medial Branch Block and Facet Joint Injection in Axial Low Back Pain. Pain Res. Manag. 2021, 2021, 1343891, doi:10.1155/2021/1343891.
40. Schol, J.; Ambrosio, L.; Tamagawa, S.; Joyce, K.; Ruiz-Fernández, C.; Nomura, A.; Sakai, D. Enzymatic Chemonucleolysis for Lumbar Disc Herniation—an Assessment of Historical and Contemporary Efficacy and Safety: A Systematic Review and Meta-Analysis. Sci. Rep. 2024, 14, 12846, doi:10.1038/s41598-024-62792-8.
41. Franco, D.; Mahtabfar, A.; Hines, K.; Sabourin, V.; Stefanelli, A.; Harrop, J. Neurosurgical Evaluation for Patients with Chronic Lower Back Pain. Curr. Pain Headache Rep. 2020, 24, 58, doi:10.1007/s11916-020-00894-4.
42. Donnally III, C.J.; Hanna, A.; Varacallo, M. Lumbar Degenerative Disk Disease. In StatPearls; StatPearls Publishing: Treasure Island (FL), 2024.
43. Lang, S.A.J.; Bohn, T.; Barleben, L.; Pumberger, M.; Roll, S.; Büttner-Janz, K. Advanced Meta-Analyses Comparing the Three Surgical Techniques Total Disc Replacement, Anterior Stand-Alone Fusion and Circumferential Fusion Regarding Pain, Function and Complications up to 3 Years to Treat Lumbar Degenerative Disc Disease. Eur. Spine J. Off. Publ. Eur. Spine Soc. Eur. Spinal Deform. Soc. Eur. Sect. Cerv. Spine Res. Soc. 2021, 30, 3688–3701, doi:10.1007/s00586-021-06784-6.
44. Soares, L.O.; Ferreira, G.E.; Costa, L.O.P.; Nogueira, L.C.; Meziat-Filho, N.; Reis, F.J.J. Meditation for Adults with Non-Specific Low Back Pain: A Systematic Review and Meta-Analysis. Scand. J. Pain 2022, 22, 26–39, doi:10.1515/sjpain-2021-0096.
45. Zhang, J. Mechanisms and Clinic of Acupuncture Analgesia. Beijing People’s Med. Publ. House 2002, 136–240.
46. Goldman, N.; Chen, M.; Fujita, T.; Xu, Q.; Peng, W.; Liu, W.; Jensen, T.K.; Pei, Y.; Wang, F.; Han, X. Adenosine A1 Receptors Mediate Local Anti-Nociceptive Effects of Acupuncture. Nat. Neurosci. 2010, 13, 883–888.
47. Robinson, N.G. Interactive Medical Acupuncture Anatomy; Teton NewMedia Jackson, WY, USA, 2016; ISBN 1-59161-020-6.
48. Han, K.-H.; Cho, K.H.; Han, C.; Cui, S.; Lin, L.; Baek, H.-Y.; Kim, J. The Effectiveness and Safety of Acupuncture Treatment on Sciatica: A Systematic Review and Meta-Analysis. Complement. Ther. Med. 2022, 71, 102872, doi:10.1016/j.ctim.2022.102872.
49. Hui, K.K.S.; Liu, J.; Marina, O.; Napadow, V.; Haselgrove, C.; Kwong, K.K.; Kennedy, D.N.; Makris, N. The Integrated Response of the Human Cerebro-Cerebellar and Limbic Systems to Acupuncture Stimulation at ST 36 as Evidenced by fMRI. NeuroImage 2005, 27, 479–496, doi:10.1016/j.neuroimage.2005.04.037.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Maciej Gołębski , Wojciech Nowak, Jagoda Mikołajczyk , Zuzanna Kukla , Stella Mieruszyńska , Paulina Krzemińska , Mirosław Sawicki , Izabela Sadowska , Jakub Włosiański , Sebastian Musialik
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 92
Number of citations: 0
