An evidence-based approach to the management of low back pain and sciatica: how the evidence is applied in clinical cases.
BACKGROUND
Low back pain and sciatica are common complaints that affect a major proportion of the population at some time in their lives. The treatment and management of this condition may vary widely.


OBJECTIVE
The present paper aims to provide an evidence-based approach to the management of low back pain and sciatica, and demonstrates how to search for the evidence and how to apply it practically in individual patients. The principles underlying evidence-based medicine are explained. The practice of evidence-based medicine requires initial formulation of the appropriate clinical question, followed by searching databases for relevant evidence. Finally evidence needs to be applied on a patient-specific basis.


METHODS
Best Evidence, the Cochrane Library, Embase and Medline were searched to obtain quality controlled information regarding the management of low back pain and sciatica.


RESULTS
Current evidence shows that an active exercise programme promotes early recovery. This may allow patients to resume an active and sportive lifestyle. Epidural corticosteroid injections may help to resolve additional troublesome symptoms of sciatica. Two clinical cases are used to show how evidence-based medicine can be individualized to specific patients.


CONCLUSIONS
A patient-focused strategy combining best evidence and clinical expertise is suggested as the mainstay for the management of low back pain.
Goh
L
L
Haywood Hospital, Staffordshire Rheumatology Centre, Stoke on Trent.
Bawendi
A
A
Samanta
J
J
Samanta
A
A
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000529:Complementary Therapies; D017586:Diskectomy; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D006801:Humans; D007268:Injections, Epidural; D007270:Injections, Intra-Articular; D017116:Low Back Pain / Q000628:therapy*; D020393:Manipulation, Spinal; D012585:Sciatica / Q000628:therapy*; D004561:Transcutaneous Electric Nerve Stimulation; D021801:Zygapophyseal Joint
D000305:Adrenal Cortex Hormones