Chiropractic, Sciatica and Adverse Drug Effects

​Sciatica is a significant burden to healthcare and the economy, due to the neuropathic component in low back pain, it is linked to poorer quality of life and it also increases the already high cost of back pain by a further 67% (1). Do you or a loved one experience sciatica? This is an important article that could make the world of difference to you.
 
“The lifetime incidence of sciatica is reported to be between 10%-40%” (2)
 
Sciatica is usually characterised by pain or paraesthesia within the sciatic nerve distribution, so it is usually back pain accompanied with pain/paraesthesia down the back of the leg, it could be typical pain or it could also be a burning sensation. Though less common, it can also be associated with leg weakness on the side that the sciatic nerve is affected (3).

Opioids are frequently prescribed to treat sciatica, although there is limited evidence of efficacy with this condition (4-7). There is also commonly a range of adverse effects including constipation, dizziness, and sedation and less often, nausea and vomiting. In addition to the potential for misuse, long-term use, dependency, addiction, and respiratory depression leading to death (8). Can chiropractic care help manage sciatica effective enough so that opioids can be avoided?
 
In recent research literature, a search was conducted on the US claims-based data resource of more than 216 million patients, from data ranging from 2009-2024. They looked at patients older than 18 with sciatica, excluding those of post-spine surgery, prior anaesthesia, serious pathology, high risk of ORADEs (opioid-related adverse drug events) and an ORADE £ 1 year prior (9). Of that huge data resource, 372,471 patient data fit the criteria being looked at and were used for this study. The patients were divided into 2 groups, those who received chiropractic care and those who received usual medical care. It was found that adults with sciatica who initially received chiropractic care had a lower risk of an ORADE compared to those who received usual medical care, likely explained by a lower probability of opioid prescription (9). So the findings support chiropractic care for management of sciatica and perhaps reduce the probability to have to turn towards opioids. More research would be needed to further substantiate these findings, though the results are quite positive so far.

So if you want to find out if chiropractic care may help manage sciatica for you or your loved ones, have a chat with one of our chiropractors to see how they can assist.
 
“Where possible it would be more beneficial to turn to natural therapy for support rather than pharmaceuticals”
 
 
References
1. Schmidt, C.O., Schweikert, B., Wenig, C.M., Schmidt, U., Gockel, U., Freynhagen, R., Tölle, T.R., Baron, R. and Kohlmann, T., 2009. Modelling the prevalence and cost of back pain with neuropathic components in the general population. European Journal of Pain, 13(10), pp.1030-1035.
2. Stafford, M.A., Peng, P. and Hill, D.A., 2007. Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. British journal of anaesthesia, 99(4), pp.461-473.
3. Davis, D., Maini, K., Taqi, M. and Vasudevan, A., 2024. Sciatica. In StatPearls [Internet]. StatPearls Publishing.
4. Coyne, K.S., Barsdorf, A.I., Currie, B.M., Poon, J.L., Maziere, J.Y., Pierson, R.F., Butler, S.F., Schnoll, S.H., Farrar, J.T., Fisher, H.J. and Franks Jr, M.J., 2021. Insight into chronic pain in the United States: descriptive results from the Prescription Opioid Misuse and Abuse Questionnaire (POMAQ) validation study. Current Medical Research and Opinion, 37(3), pp.483-492.
5. Di Gangi, S., Pichierri, G., Zechmann, S., Rosemann, T. and Plate, A., 2021. Prescribing patterns of pain medications in unspecific low back pain in primary care: A retrospective analysis. Journal of Clinical Medicine, 10(7), p.1366.
6. Manniche, C., Stokholm, L., Ravn, S.L., Andersen, T.E., Brandt, L., Rubin, K.H., Schiøttz-Christensen, B. and Skousgaard, S.G., 2022. The prevalence of long-term opioid therapy in spine center outpatients following initiation of tramadol: the Spinal Pain Opioid Cohort (SPOC). Chronic Pain & Management, 6, p.145.
7. Price, M.R., Mead, K.E., Cowell, D.M., Troutner, A.M., Barton, T.E., Walters, S.A. and Daniels, C.J., 2024. Medication recommendations for treatment of lumbosacral radiculopathy: A systematic review of clinical practice guidelines. PM&R, 16(10), pp.1128-1142.
8. Benyamin, R., Trescot, A.M., Datta, S., Buenaventura, R.M., Adlaka, R., Sehgal, N., Glaser, S.E. and Vallejo, R., 2008. Opioid complications and side effects. Pain physician, 11(2S), p.S105.
9. Trager, R.J., Cupler, Z.A., Srinivasan, R., Harper, E.G. and Perez, J.A., 2025. Association between chiropractic spinal manipulation for sciatica and opioid-related adverse events: A retrospective cohort study. PLoS One, 20(1), p.e0317663