Effectiveness of Nonsurgical Interventions for Patients With Acute and Subacute Sciatica: A Systematic Review With Network Meta-Analysis

OBJECTIVE: To investigate the comparative effectiveness of nonsurgical interventions for adults with acute and subacute sciatica. 

DESIGN: Intervention systematic review with network meta-analysis

LITERATURE SEARCH: Embase, MEDLINE, Cochrane Library, and CINAHL were searched up to June 7, 2024. 

STUDY SELECTION CRITERIA: Randomized controlled trials of nonsurgical interventions in adults (aged 18 years or older) with acute or subacute sciatica (less than 3 months) were included. • DATA SYNTHESIS: The primary outcomes were leg pain intensity and physical function at different follow-up time points. Secondary outcomes were adverse events, mental health, and low back pain intensity. Two reviewers independently conducted screening, data extraction, and risk-of-bias assessment. Random-effects network meta-analysis was conducted, and confidence was evaluated by the Confidence in Network Meta-Analysis (CINeMA) method. 

RESULTS: Forty randomized controlled trials (5381 participants) were included. At short-term follow-up, compared to sham treatment/ placebo, the most efficacious interventions for leg pain intensity were NSAIDs + physical therapy modalities, antibiotics, and antidepressants. Music therapy was effective for improving physical function at short-term follow-up. At long-term follow-up, steroids had a significant effect in reducing leg pain and improving physical function. No intervention showed a significant increase in adverse events compared with sham-treatment/ placebo. All the evidence was based on very low confidence, primarily due to within-study bias and imprecision in effect estimates. 

CONCLUSIONS: Very low–confidence evidence supported some nonsurgical interventions for improving leg pain intensity and physical function in people with acute and subacute sciatica.