Non-steroidal anti-inflammatory drugs for sciatica.An updated Cochrane review.

STUDY DESIGN: Systematic review and meta-analysis.

OBJECTIVE: To determine the efficacy of Nonsteroidal anti-inflammatory drugs (NSAIDs) on pain reduction, overall improvement, and reported adverse effects in people with sciatica.

SUMMARY OF BACKGROUND DATA: NSAIDs are one of the most frequently prescribed drugs for sciatica.

METHODS: We updated a 2008 Cochrane Review through June 2015. Randomized controlled trials that compared NSAIDs to placebo, to other NSAIDs, or to other medication were included. Outcomes included pain using mean difference (MD, 95% confidence intervals 95%CI). For global improvement and adverse effects risk ratios (RR,95% CI) were used. We assessed level of evidence using the GRADE approach.

RESULTS: Ten trials were included (N = 1651). Nine out of ten trials were assessed at high risk of bias. For pain reduction (Visual Analogue Scale, 0 to 100) NSAIDs were no more effective than placebo (MD -4.56, 95% CI -11.11 to 1.99, quality of evidence: very low). For global improvement NSAIDs were more effective than placebo (RR 1.14 (95%CI 1.03 to 1.27, low quality of evidence). One trial reported the effect of NSAIDs on disability with very low quality evidence that NSAIDs are no more effective than placebo. There was low-quality evidence that the risk for adverse effects is higher for NSAID than placebo (RR 1.40, 95%CI 1.02 to 1.93).

CONCLUSION: Our findings show very low quality evidence that the efficacy of NSAIDs for pain reduction is comparable to that of placebo, low quality evidence that NSAIDs is better than placebo for global improvement and low quality evidence for higher risk of adverse effects using NSAIDs compared to placebo. The findings must be interpreted with caution, due to small study samples, inconsistent results and a high risk of bias in the included trials.