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Opioids 'not effective' treatment for sciatica

Opioid therapy is not an effective treatment for sciatica, despite being widely used for the condition, an NHS health technology assessment has found.

The review of 270 studies, shortly due to be published in full online, found surgery, epidural steroid injections and non-opioid drugs ­ including NSAIDs, muscle relaxants and amitriptyline ­ appeared the best available treatments.

Odds ratios for a 'global effect', compared with inactive controls, were 2.8 for surgery, 3.1 for epidural steroids and 2.6 for non-opioid medication, although disc surgery and epidural injections were associated with some adverse effects.

Chemonucleolysis ­ a procedure no longer used in the UK which involves dissolving the gelatinous cushioning material in an intervertebral disc by injection of an enzyme such as chymopapain ­ did also show evidence of effectiveness, with a doubling of the odds of a global effect compared with controls.

But the study concluded opioid medication was found to be 'less effective than the comparator interventions and associated with more adverse effects than the inactive control'.

There was some evidence that although used less frequently, biological agents and acupuncture might prove useful, researchers from Cardiff University School of Medicine found.

Study leader Ruth Lewis, a lecturer at the North Wales Centre for Primary Care Research, said patients and doctors were often faced with a wide choice of interventions for sciatica, but this was the first time all had been compared head-to-head: 'The most interesting finding was that opioids are not effective. The lack of effect is probably due to the type of pain you're dealing with.'

Dr Louise Warburton, a GPSI in rheumatology and musculoskeletal medicine in Shrewsbury and president of the Primary Care Rheumatology Society, said: 'Most GPSIs will be using assessment similar to that proposed in the START trials from Keele University.'

'This uses a stratification tool to assess what sort of interventions patients need at presentation. If we could roll out a national assessment of back pain along these lines, it would be much more useful.'

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