Understanding Sciatica: How do people with lumbar radicular pain understand their condition and how does this impact on their views regarding treatment?

Talk Code: 
5B.4
Presenter: 
Robert Goldsmith
Co-authors: 
Dr Nefyn Williams, Dr Fiona Wood.
Author institutions: 
Bangor University, Cardiff and Vale UHB, University of Liverpool, Cardiff University

Problem

Background: Several pathological processes contribute to lumbar radicular pain. It is not known how patients rationalise the experience of sciatica or understand the diagnosis. Providing clinicians with a better understanding of how patients conceptualise sciatica will help them to tailor information for patients on the management and treatment of the condition. Objectives: To understand patients’ beliefs regarding their illness following a diagnosis of lumbar radicular pain, how these were developed, and the impact on beliefs regarding treatments.

Approach

Design: Single centre, qualitative studyMethod: Thirteen patients recently diagnosed with lumbar radicular pain were purposively recruited from a single UK based NHS primary care service. Individual semi-structured interviews were recorded and transcribed. Data were analysed using a thematic approach.

Findings

Four main themes were generated: (1) the illness experience (2) the concept of sciatica, (3) treatment beliefs and (4) the desire for credible information.1. Participants emphasised the severity and unpredictability of the pain experience, which was ‘mentally and physically draining’. Three participants expressed suicidal thoughts. Participants felt that they were not taken seriously as symptoms were confusing to explain and that their symptoms were underappreciated, illegitimate and ‘invisible’.2. All participants saw their illness as being caused by a mechanical (rather than chemical or ischemic) insult to neural tissue, caused by a disc enlarging. Inflammation was perceived to be involved in these processes by increasing the size of the disc or surrounding tissues. When an MRI failed to adequately explain their experience, participants were left feeling invalidated, frustrated and confused. 3. The compressive illness constructs appeared to have influenced beliefs regarding treatment effectiveness. Treatments addressing compression (e.g. surgery) were easily understood and perceived as having more control over the condition. Those treatments seeking to address inflammatory or neuropathic mechanisms (e.g. medication or NRB) were confusing and therefore perceived as less powerful.4. Participants expressed a desire for credible information as it was an important step in understanding their illness before considering treatment. Participants appreciated the use of plastic models of the spine to help explanations and highly valued clinicians taking the time to show them their MRI scan. It is likely that the use of plastic models and visualisation of MRI will have influenced the illness construct of participants.

Consequences

The diagnosis of lumbar radicular pain remains grounded in a compressive conceptual illness identity. Explaining symptoms using a compressive pathological model seems acceptable to patients but may not accurately reflect the spectrum of pathological processes known to contribute to radicular pain. This model appears to inform patient beliefs about treatments. Clinicians should take care to fully explain the pathology prior to shared decision making with patients.

Submitted by: 
Robert Goldsmith
Funding acknowledgement: 
This research and preparation of the manuscript was supported by a First into Research Fellowship from Research Capacity Building Collaboration, Wales. We gratefully acknowledge additional funding for qualitative research training provided by a research award from the Musculoskeletal Association of Chartered Physiotherapists.