By Vishwadha Chander
(Reuters Health) – One in four older Americans has experienced the sharp, sometimes disabling, pain of sciatica, and these older adults are more prone to have other illnesses and lowered quality of life, a new U.S. study suggests.
Based on surveys of more than 1 million men and women, researchers found that about one quarter had been diagnosed with this common form of back pain that usually begins in the spine and radiates down the leg.
Compared to people without a history of sciatica, those with the condition tended to have higher rates of other physical ailments and depression, researchers note in the Journal of the American Academy of Orthopaedic Surgeons.
Previous research has shown that sciatica is common, but the current study looks at how the disorder affects patients over the years, said Dr. Joseph Maslak of the Cleveland Clinic in Ohio, who led the study while a surgical resident at Northwestern University in Chicago.
Maslak and his colleagues analyzed data collected between 2007 and 2012 in annual surveys of people over age 66 with coverage under Medicare, the federal health program for the elderly. In addition to general background information, the surveys asked participants about chronic medical and mental health conditions, daily activity, and how they felt about their physical health. Researchers followed up with willing participants after two years.
Of the roughly one million people included in the analysis, 250,869 said in their original interview that they had been diagnosed with sciatica, and 750,083 had no history of the condition. After two years, 112,260 patients with sciatica completed follow-up interviews along with 355,236 people without sciatica.
The researchers found that people with sciatica were more likely to suffer from other health issues like hypertension, heart disease, obesity and stroke. Around 72% of patients who reported having sciatica also had hypertension, for example, compared with 63% of those without the condition.
More sciatica patients also had coronary heart disease, a history of heart attacks, chronic obstructive pulmonary disease, inflammatory bowel syndrome, diabetes and were “notably” more likely to report a recent fall.
Rates of self-reported depression were also nearly double (34%) among people with sciatica compared to others (16%). After two years, these rates fell only slightly in both groups.
Similarly, 48% of people with sciatica described their own health as fair to poor in the baseline interview, compared with 25% of people without sciatica, and there was little improvement in either group two years later.
The study was not designed to determine whether sciatica directly causes other physical or mental health conditions or is influenced by them, the authors note. But it’s certainly possible that patients suffering from the effects of sciatica may be more susceptible to depression, or patients with depression may have an altered reaction to sciatica pain, for instance.
Given the strong associations seen between sciatica and other common health conditions, “these patients should be approached holistically,” the study authors write, “with sciatica being potentially an indicator of overall health.”
This study is important for doctors to identify patients for appropriate multidisciplinary care, Maslak told Reuters Health in an email. “This will help decrease costs and improve the quality of life.”
The study “does raise interesting questions about sciatica causing mental and physical discomfort,” said Dr. Houman Danesh, director of the Division of Integrative Pain Management at The Mount Sinai Hospital in New York city, who was not part of the study.
“The Medicare population is an at-risk group of patients, and continued research is necessary to afford them the care they deserve,” Maslak said.
It is also important for patients to focus not just on pain reduction but to have goals, Danesh said.
“They should say, ‘I want my pain to be less so that I can get on my knees and play with my grandchildren or play basketball with my son for two hours.”
SOURCE: https://bit.ly/2oh9VHa Journal of the American Academy of Orthopaedic Surgeons, online September 9, 2019.
