The Challenges of Treating Sciatica Pain in Older Adults

Ferreira, Manuela L; McLachlan, Andrew J.

doi:10.1007/s40266-016-0404-z

Cited by 10 publications

(9 citation statements)

References 54 publications

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“…Obviously, diseases become more prevalent with advanced age and with them the use of multiple medications [ 2 , 3 ]. The use of medication by older people has increased 3- to 5-fold over the past decades and is expected to rise even more [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Paracetamol in Older People: Towards Evidence-Based Dosing?

et al. 2018

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Paracetamol is the most commonly used analgesic in older people, and is mainly dosed according to empirical dosing guidelines. However, the pharmacokinetics and thereby the effects of paracetamol can be influenced by physiological changes occurring with ageing. To investigate the steps needed to reach more evidence-based paracetamol dosing regimens in older people, we applied the concepts used in the paediatric study decision tree. A search was performed to retrieve studies on paracetamol pharmacokinetics and safety in older people (> 60 years) or studies that performed a (sub) analysis of pharmacokinetics and/or safety in older people. Of 6088 articles identified, 259 articles were retained after title and abstract screening. Further abstract and full-text screening identified 27 studies, of which 20 described pharmacokinetics and seven safety. These studies revealed no changes in absorption with ageing. A decreased (3.9–22.9%) volume of distribution (Vd) in robust older subjects and a further decreased Vd (20.3%) in frail older compared with younger subjects was apparent. Like Vd, age and frailty decreased paracetamol clearance (29–45.7 and 37.5%) compared with younger subjects. Due to limited and heterogeneous evidence, it was difficult to draw firm and meaningful conclusions on changed risk for paracetamol safety in older people. This review is a first step towards bridging knowledge gaps to move to evidence-based paracetamol dosing in older subjects. Remaining knowledge gaps are safety when using therapeutic dosages, pharmacokinetics changes in frail older people, and to what extent changes in paracetamol pharmacokinetics should lead to a change in dosage in frail and robust older people.Electronic supplementary materialThe online version of this article (10.1007/s40266-018-0559-x) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Paracetamol in Older People: Towards Evidence-Based Dosing?

et al. 2018

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“…The preoperative disability associated with sciatica in the elderly is so incapacitating that affected individuals report a quality of life that is comparable to those with a history of COPD, stroke, or myocardial infarction 22. Thus, effective treatments for sciatica in the elderly should be identified since there is a paucity of clinical guidance specific to this underrepresented population 24,25…”

Section: Discussionmentioning

confidence: 99%

<p>Clinical performance of a bone-anchored annular closure device in older adults</p>

Bouma¹,

Ardeshiri²,

Miller³

et al. 2019

CIA

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Background: Lumbar discectomy is a common surgical procedure in middle-aged adults. However, outcomes of lumbar discectomy among older adults are unclear. Methods: Lumbar discectomy patients with an annular defect ≥6 mm width were randomized to receive additional implantation with a bone-anchored annular closure device (ACD, n=272) or no additional implantation (controls, n=278). Over 3 years follow-up, main outcomes were symptomatic reherniation, reoperation, and the percentage of patients who achieved the minimum clinically important difference (MCID) without a reoperation for leg pain, Oswestry Disability Index (ODI), SF-36 Physical Component Summary (PCS) score, and SF-36 Mental Component Summary (MCS) score. Results were compared between older (≥60 years) and younger (<60 years) patients. We additionally analyzed data from two postmarket ACD registries to determine consistency of outcomes between the randomized trial and postmarket, real-world results. Results: Among all patients, older patients suffered from crippling or bed-bound preoperative disability more frequently than younger patients (57.9% vs 39.1%, p =0.03). Among controls, female sex, higher preoperative ODI, and current smoking status, but not age, were associated with greater risk of reherniation and reoperation. Compared to controls, the ACD group had lower risk of symptomatic reherniation (HR=0.45, p <0.001) and reoperation (HR=0.54, p =0.008), with risk reductions comparable in older vs younger patients. The percentage of patients achieving the MCID without a reoperation was higher in the ACD group for leg pain (81% vs 72%, p =0.04), ODI (82% vs 73%, p =0.03), PCS (85% vs 75%, p =0.01), and MCS (59% vs 46%, p =0.007), and this benefit was comparable in older versus younger patients. Comparable benefits in older patients were observed in the postmarket ACD registries. Conclusion: Outcomes with lumbar discectomy and additional bone-anchored ACD are superior to lumbar discectomy alone. Older patients derived similar benefits with additional bone-anchored ACD implantation as younger patients.

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“…Pain medication discussions may also be underpinned by the considerable side effects associated with numerous pharmacological interventions for LBRLP [7], and with uncertainty regarding medication efficacy and tolerability [6], major international clinical guidelines for non-specific low back and leg pain now discourage the use of analgesic medication for this condition [11, 26, 27]. Chiropractors presently do not have medication prescription rights in Australia [28], yet a baseline level of pharmacological understanding, such as medication usage and harmful interactions between different medications or adverse drug reactions [29] is essential knowledge for chiropractors [30], particularly in older people with LBRLP [31]. Importantly, many other factors may influence a chiropractor’s decision to discuss medication with patients that are not solely due to LBRLP.…”

Section: Discussionmentioning

confidence: 99%

The profile of chiropractors managing patients with low back-related leg pain: analyses of 1907 chiropractors from the ACORN practice-based research network

et al. 2019

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Background Approximately 60% of people with low back pain also have associated leg pain symptoms. Guidelines for low back pain recommend non-pharmacological approaches, including spinal manipulation - a therapy provided by chiropractors. However, limited empirical data has examined the characteristics of chiropractors managing patients with low back-related leg pain (LBRLP). Our objective is to describe the prevalence, profile and practice characteristics of Australian chiropractors who often treat LBRLP, compared to those who do not often treat LBRLP. Methods This is a cross-sectional analysis of a nationally representative sample from the Australian Chiropractic Research Network (ACORN). This study investigated the demographic and practice characteristics as well as clinical management of chiropractors who ‘often’ treated patients with LBRLP compared to those who treated LBRLP ‘never/rarely/sometimes’. Multiple logistic regression models identified independent factors associated with chiropractors who ‘often’ treated patients with LBRLP. Results A total of 1907 chiropractors reported treating patients experiencing LBRLP, with 80.9% of them ‘often’ treating LBRLP. Chiropractors who ‘often’ treated LBRLP were more likely to manage patients with multi-site pain including axial low back pain (OR = 21.1), referred/radicular neck pain (OR = 10.8) and referred/radicular thoracic pain (OR = 3.1). While no specific management strategies were identified, chiropractors who ‘often’ treated LBRLP were more likely to discuss medication (OR = 1.8), manage migraine (OR = 1.7) and degenerative spine conditions (OR = 1.5), and treat women during pregnancy (OR = 1.6) and people with work-related injuries (OR = 1.5), compared to those not treating LBRLP frequently. Conclusions Australian chiropractors frequently manage LBRLP, although the nature of specific management approaches for this condition remains unclear. Further research on the management of LBRLP can better inform policy makers and educators interested in upskilling chiropractors to deliver safe and effective treatment of LBRLP.

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The Challenges of Treating Sciatica Pain in Older Adults

Cited by 10 publications

References 54 publications

Paracetamol in Older People: Towards Evidence-Based Dosing?

Paracetamol in Older People: Towards Evidence-Based Dosing?

<p>Clinical performance of a bone-anchored annular closure device in older adults</p>

The profile of chiropractors managing patients with low back-related leg pain: analyses of 1907 chiropractors from the ACORN practice-based research network

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