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Nerve blocks help sciatica, but adding physical therapy doesn’t help more

PainSci » bibliography » Thackeray et al 2010
Tags: treatment, sciatica, back pain, physical therapy, injections, neurology, pain problems, spine, butt, hip, manual therapy, medicine

Two articles on PainSci cite Thackeray 2010: 1. The Complete Guide to Low Back Pain2. Do Nerve Blocks Work for Neck Pain and Low Back Pain?

PainSci commentary on Thackeray 2010: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

A small trial comparing the effect of nerve root blocks with or without physical therapy in 44 patients. They got their injections and either did or didn’t receive PT for four weeks. There was no difference between the groups: everyone seemed to do equally well, or poorly. They all improved, but without a placebo group for comparison, there’s no way to tell if the nerve blocks helped: all this study tells us is that nerve blocks and PT were not harmful, and were equally effective or ineffective … and that PT added nothing of value to the process, and just bombed with these butts.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Therapeutic selective nerve root blocks (SNRBs) are a common intervention for patients with sciatica. Patients often are referred to physical therapy after SNRBs, although the effectiveness of this intervention sequence has not been investigated.

OBJECTIVE: This study was a preliminary investigation of the effectiveness of SNRBs, with or without subsequent physical therapy, in people with low back pain and sciatica.

DESIGN: This investigation was a pilot randomized controlled clinical trial.

SETTING: The settings were spine specialty and physical therapy clinics.

PARTICIPANTS: Forty-four participants (64% men; mean age=38.5 years, SD=11.6 years) with low back pain, with clinical and imaging findings consistent with lumbar disk herniation, and scheduled to receive SNRBs participated in the study. They were randomly assigned to receive either 4 weeks of physical therapy (SNRB+PT group) or no physical therapy (SNRB alone [SNRB group]) after the injections. Intervention All participants received at least 1 SNRB; 28 participants (64%) received multiple injections. Participants in the SNRB+PT group attended an average of 6.0 physical therapy sessions over an average of 23.9 days. Measurements and outcomes were assessed at baseline, 8 weeks, and 6 months with the Low Back Pain Disability Questionnaire, a numeric pain rating scale, and the Global Rating of Change.

RESULTS: Significant reductions in pain and disability occurred over time in both groups, with no differences between groups at either follow-up for any outcome. Nine participants (5 in the SNRB group and 4 in the SNRB+PT group) underwent surgery during the follow-up period.

LIMITATIONS: The limitations of this study were a relatively short-term follow-up period and a small sample size.

CONCLUSIONS: A physical therapy intervention after SNRBs did not result in additional reductions in pain and disability or perceived improvements in participants with low back pain and sciatica.

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