Medications for lumbosacral radiculopathy – what does the evidence say?

Globally, the number of years lived with disability due to low back pain increased by 52.7% between 1990 and 2015. In primary care offices, 38% of patients seek care for low back related leg pain, with 14% reporting radiation of pain below the knee. We know that patients with lumbosacral radicular symptoms are more likely to utilize medication, but what does the evidence say about their effectiveness? Several guidelines for low back pain have been revised and updated in recent years but there is currently no systematic review assessing clinical practice guidelines for the management of lumbosacral radicular symptoms.

The purpose of this systematic review was to summarize guidelines that provide recommendations on the pharmaceutical management of lumbosacral radicular symptoms, while also assessing the quality of the guidelines.

Note from Dr. Thistle:

Not to spoil the punchline for this review, but there is a general lack of consensus relating to the use of medications for lumbosacral radiculopathy. For those of us who have been reading and following the medical literature for years, it reads as expected! The evidence really isn’t conclusive for many medications that are often prescribed for these patients, while the evidence for the effectiveness of manual and more conservative interventions continues to grow. I realize medications are entirely out of scope for most clinicians reading this, but I think it is our responsibility to be aware of the evidence so we can have informed discussions with both patients, and other health care providers.

RESEARCH REVIEW: Medications for Lumbosacral Radiculopathy: Clinical Guidelines Overview

This paper was published in PM&R (2024)

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