Nonsteroidal anti-inflammatory drugs (NSAIDs) are aspirin-like drugs used to decrease inflammation, pain and fever. Commonly used NSAIDs include aspirin, ibuprofen, naproxen, and celecoxib. This class of drugs is frequently used in the treatment of a wide variety of disorders that affect the musculoskeletal system, such as osteoarthritis and rheumatoid arthritis.
With this knowledge in mind, a group of European investigators reviewed the medical literature to report on the effectiveness of NSAIDs in the treatment of sciatica. Sciatica is a symptom associated with pain radiating down a leg below the knee to the ankle or foot. Two common disorders associated with sciatica include nerve compression caused by a herniated spinal disc or spinal stenosis.
Out of 2629 references, 10 reported, comparative controlled clinical trials were thought adequate to be included in the review. The outcome measures that were pertinent included those that calculated changes in pain intensity, overall improvement, disability or functional status and the degree of side effects. The authors also judged articles in regard to the degree that bias might affect the results of the studies.
In regard to pain relief, no significant difference was measured between NSAIDs and placebo. Also, in the one study that reported the effect on disability, NSAIDs were no more effective than placebo. However, in regard to overall improvement, NSAIDs were more effective than placebo. NSAIDs did have greater side effects. In regard to bias, the authors detected a high risk because of the small number of patients and the inconsistency of the use of measurement tools in the included studies. Also of interest was the fact that three of the reported studies included a NSAID no longer available for human use because of side effects.
At this time additional studies are needed to determine the overall benefit and risk of NSAIDs in the treatment of sciatica. Patients taking NSAIDs for sciatica should realize that global improvement is a possibility but at a cost of increased side effects.
Reference: Rasmussen-Barr E et al: Nonsteroidal anti-inflammatory drugs for sciatica. Spine 2017;42:586-594
David Borenstein, M.D.
Executive editor TheSpineCommunity