Liverpool-led study aims to find best treatment for back pain

Liverpool-led study aims to find best treatment for back pain

A major research project has been launched in Liverpool to find the best treatment for sciatica, a common type of severe back pain.

Consultant neurosurgeon and Chief Investigator for the study Mr Martin Wilby

Above: Consultant neurosurgeon and Chief Investigator for the study Mr Martin Wilby

Led by specialists in spinal surgery and pain at The Walton Centre NHS Foundation Trust, the £1 million project will study the benefits of surgery compared with pain killing injections.

Sciatica is the name given to any sort of pain that is caused by irritation or compression of the sciatic nerve, which runs through the back of the pelvis down both legs.

Lead consultant in spinal surgery Mr Martin Wilby is the Chief Investigator for the study. He said: “We have been running a new combined pain and spinal surgery clinic for the last 18 months and we find that patients are being referred to us quite late in their pain episode.

“Sometimes, patients suffering for a long time with sciatica find their whole quality of life has suffered and they are at risk of losing their jobs. We want to see these people earlier, between six weeks and six months of pain duration, and help them return to a normal life as soon as possible so they keep their jobs.”

The option of using a local anaesthetic and steroid to treat sciatica involves numbing the sciatic nerve for a period of hours, giving short-term relief while the steroid has a long-term effect reducing inflammation in the joint and around the nerve.

The other option is spinal surgery, to remove the part of the disc causing the sciatica.

Clinical Director of Pain Medicine Dr Manohar Sharma explained: “While the majority of patients benefit from the operation, not all people actually need it.

“We believe that possibly half of people undergoing this surgery could be treated just as successfully without the operation, avoiding the associated risks and discomfort. This is why we are conducting the study.”

In many cases, sciatica will get better spontaneously and can be successfully managed with simple analgesics and physiotherapy. When it persists, the sufferer should contact their GP and after about 6 weeks if the condition continues, the GP can refer the patient to The Walton Centre for an MRI scan and possible inclusion in the sciatica study.

The study will begin recruitment in January 2015 hopefully extending nationally by the summer. The results are hoped to lead to a major change in practice, with new guidelines for treating sciatica leading to better use of resources and better outcomes for patients.

Patient story: Stephen Lawlor

Patient Stephen Lawlor

Above: Patient Stephen Lawlor

Stephen Lawlor suffered ‘ten months of hell’ before finally receiving treatment which cured his sciatica.

Long running problems with his back suddenly became much worse in July 2012, just a few months after Stephen had launched a new business, in specialist construction.

“I was in excruciating pain and I couldn’t walk or sit for more than a few minutes. I was crawling on all fours or lying on the living room floor and trying to run my new business on my phone and computer,” said Stephen.

“I went to see my GP and he referred me to a physio which took six weeks; then I was referred for a musculoskeletal assessment which took another seven weeks; then I was referred to the physio again.

“It was only when the physio told me he couldn’t help and I should go back to my GP and insist on an MRI scan, that things started to move. I was referred for a scan and then I saw Mr Martin Wilby who offered me medication; an injection and surgery.

“He told me I should have all three options and I had the injection at The Walton Centre two weeks later. It worked immediately; from feeling like a 95 year old man and spending most of the time horizontal on the floor, I could start to function normally again.

“Three months later I had the discectomy operation to remove the part of a disc which was resting on the sciatic nerve. Straight away, the pain down my leg and foot went completely. My back was a bit tender for a few weeks but it was fantastic that the pain went immediately.

“I received a fantastic service at The Walton Centre; Mr Wilby’s treatment has had a massive effect on my life. I do think it is critical that other patients and GPs are made aware of the fast track clinic and the research which will eventually help patients everywhere.”