title: Nonsteroidal Anti-inflammatory Drugs for Sciatica: An Updated Cochrane Review.
abstract: METHODS
  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.
  
  
  BACKGROUND
  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 with placebo, with other NSAIDs, or with 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 Grades of Recommendation, Assessment, Development and Evaluation approach.
  
  
  RESULTS
  Ten trials were included (N = 1651). Nine out of 10 trials were assessed at high risk of bias. For pain reduction (visual analog 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).
  
  
  CONCLUSIONS
  Our findings show very low-quality evidence that the efficacy of NSAIDs for pain reduction is comparable with 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 with 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.
  
  
  METHODS
  1.
authors.affiliation: The Institute of Environmental Medicine, Department of Cardiovascular Epidemiology, Karolinska Institutet, Stockholm, Sweden.|Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Rasmussen-Barr
authors.affiliation: Horten Centre for Patient Oriented Research, University of Zurich, Zurich, Switzerland.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Held
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Wilhelmus J A
authors.initials: WJA
authors.lastname: Grooten
authors.affiliation: Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.
authors.forename: Pepijn D D M
authors.initials: PDDM
authors.lastname: Roelofs
authors.affiliation: Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.affiliation: Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands.
authors.forename: Maurits W
authors.initials: MW
authors.lastname: van Tulder
authors.affiliation: Horten Centre for Patient Oriented Research, University of Zurich, Zurich, Switzerland.
authors.forename: Maria M
authors.initials: MM
authors.lastname: Wertli
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy*; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy*; D010147:Pain Measurement; D016032:Randomized Controlled Trials as Topic; D012585:Sciatica / Q000188:drug therapy*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal