Understanding sciatica: illness and treatment beliefs in a lumbar radicular pain population. A qualitative interview study

Robert Goldsmith; Nefyn Howard Williams; Fiona Wood

doi:10.3399/bjgpopen19X101654

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Symptoms duration >4 weeks
Unilateral leg pain radiating below the knee
Leg pain worse than, or as bad as, back pain (if present)
Positive straight leg raise test OR muscle weakness in one myotome OR loss of sensation in one dermatome
No pain in contralateral leg below the gluteal margin

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Table 1. Participant characteristics

Alias, age, sex	Occupation and work status	Symptoms	Duration	Course	Imaging	Treatments received	RMDQ	TSK	Management plan
Edward 71, M	Retired	Leg pain	40 years	Episodic (not in an episode at the time of interview)	MRI	Medication, acupuncture, chiropractic, physiotherapy	1/24	32	Self-management
Myfanwy, 53, F	Police officer; on sick leave due to symptoms	Leg pain > back pain	8 months	Episodic	MRI	Medication, chiropractic, physiotherapy, spinal injection	11/24	41	Review with APP
Gordon, 57, M	Delivery driver; unemployed; stopped work due to symptoms	Leg pain	10 months	Severe, constant	XRMRI	Medication	22/24	43	Physiotherapy
Gethin, 42, M	Employed	Leg pain> back pain, foot numbness	1 year	Constant, not changing	MRI	Osteopathy	14/24	33	Physiotherapy and review with consultant
Marley, 52, M	Self-employed, runs own training company	Leg pain	3 years	Constant, variable	MRI	Medication, osteopathy, physiotherapy, spinal surgery	3/24	23	Nerve root block±surgical opinion
Ricardo, 45, M	Engineer;occasional days off	Leg pain > back pain, foot numbness	2 years	Deteriorating	MRI	Medication, acupuncture, physiotherapy	16/24	48	Surgical opinion
Margret, 76, F	Retired	Leg pain	3 months	Improving	XR	Medication, physiotherapy	5/24	32	Self-management
Maria, 63, F	Employed carer; off work 3 months	Leg pain > back pain	9 months	Variable, but improving overall	XRMRI	Medication, acupuncture, chiropractic, physiotherapy	17/24	45	Nerve root block
Megan, 21, F	Student and works in a supermarket	Leg pain	8 months	Severe, constant, deteriorating	MRI	Medication, chiropractic, physiotherapy	20/24	43	Surgical opinion
Harry, 44, M	Civil servant; intermittent time off	Leg pain	18 years	Episodic, deteriorating	MRI	Medication, chiropractic, physiotherapy, nerve root block	18/24	45	Review with consultant
Patricia, 68, F	Retired	Leg pain and numbness	5 months	Improving	XRMRI	Medication, physiotherapy	8/24	42	Review with APP
Martha, 54, F	Teaching assistant; returned on light duties	Leg pain, foot cramps, numbness, and paraesthesia	4 months	Improving	None	Medication, osteopathy, physiotherapy	10/24	38	Physiotherapy
Hannah, 45, F	Healthcare support worker; returned on reduced hours	Leg pain, foot paraesthesia, and cramps	9 months	Severe, constant, not changing	MRI	Medication, massage therapy, physiotherapy	15/24	51	Nerve root block

APP = advanced physiotherapy practitioner. MRI = magnetic resonance imaging. RMDQ = Modified Rolland Morris Disability Questionnaire.²⁹ TSK = Tampa Scale of Kinesiophobia (>37 high score, and ≤37 low scores).²⁸ XR = X-ray.
‘>’ indicates patient’s relative rating of pain; for example, leg pain rated to be greater than back pain.

Theme	Subtheme within narrative
Illness experience	Severe, unpredictable pain Mentally and physically draining Pain not ‘visible’
Concept of sciatica	Nerves ‘tapped’ or ‘rubbed’ by a ‘swollen’ disc Confusion over role of posture, alignment, and leg length A disc might ‘shrink’ with time Compression needs to be resolved for pain to improve Confirmation of compression on MRI gives ‘validity’ to suffering Absence of compression results in frustration and a lack of validation
Treatment beliefs	Exercise: Helpful to ‘cope’, but does not address compression Weightlifting, bending, and impact might increase size of the disc or prevent it ‘shrinking’ Strength, swimming, yoga, stretching, and cycling improves 'health' and ‘protects’ the spine Warm-up improves elasticity of nerve and spinal tissues Stretching 'loosens up’ the nerve, or ‘pulls it clear' Manual therapies: ‘Realigns’ the spine, ‘frees up’ nerves, but does not address compression Massage helpful in managing symptoms Acupuncture possibly helpful, but not credible Medication and nerve root block: Temporary treatments, not a ‘fix’ Nerve root block works by ‘shrinking’ the disc, or improving the nerve ‘route’ Surgery: A powerful, definitive treatment; ‘fixes’ compression Higher risk
Desire for credible information	Seeking of information from a variety of sources Concern over credibility of information Clear explanations were highly valued Using a plastic model and MRI ‘explains’ the compression