Evidence-based practice will not help us now
A few days ago, a woman posted a message on to a local community Facebook page asking for the following advice;
Has anyone had any experience with sciatica nerve pain and useful treatment? Hubby has been in terrible pain for weeks now. Thanks for any thoughts or recommendations.
The advice that followed all came from local people and probably represented a fair snapshot of what many people currently think about the management of back pain. I've printed the whole exchange below - it's long enough to be inclusive, but not too long - so that you can draw your own conclusions, but here are a few thoughts that occurred to me reading through it.*
All posts bar one were from women. There were 39 separate postings from 29 different women over a four-day period.
A whole range of remedies were suggested, including: physiotherapy, soaking your feet in hot water and apple cider vinegar, pilates, yoga, osteopathy, magnesium, turmeric and capsicum supplements, acupuncture, chiropractic, neuro- and orthopaedic surgery, cannabis oil, ozone therapy, walking, stretches, stabilisation exercises, going to the emergency department, 'natural' healing, EFT/tapping, sports massage, sitting on a Swiss Ball, and perhaps my favourite bit of advice from Natasha that could have come from my grandmother; Try "[h]eat and some stretches. I found walking helped."
A few people offered advice to have the pain 'checked out' by an orthodox healthcare provider or recommended caution, most didn't though, preferring instead to offer treatment suggestions.
As far as it's possible to discern, all of the treatment suggestions were locally available.
Some people empathised and offered advice from their own experience, others were interested consumers and practitioners. Direct links to treatment techniques were frequently provided - bypassing the need for an expert to assess and administer the technique.
A few complained about poor standards of care from orthodox and complementary providers.
Many referred people to complementary therapists with a small number justifying this on the basis of the failure of the 'medical' system.
Physiotherapy was favourably mentioned by a handful.
Only one person offered a research-based justification for their advice.
Despite much hand-wringing from within the physiotherapy community in recent weeks, no-one mentioned the recent findings on the management of back pain published by The Lancet.
Here's the full transcript of the exchange:
Alison: Has anyone had any experience with sciatica nerve pain and useful treatment? Hubby has been in terrible pain for weeks now. Thanks for any thoughts or recommendations.
Andie: physio
Trish: Second physio
Monique: Say goodbye to sciatic nerve pain in just 10 minutes with this natural method! (see box on right for details of the method).
[su_pullquote align="right"]Say goodbye to sciatic nerve pain in just 10 minutes with this natural method!This treatment should be done at night, before bedtime. – Put about 10 liters of water in a bucket. – The water should be at the highest temperature that can be supported by the feet. – Then add a handful of salt and a half liter of apple cider vinegar. – Shake this mixture well. – Put your feet in the bucket and keep them there until the water cools. – When removing your feet, rinse them and wrap them in a dry towel and go straight to bed to sleep. – Keep your feet warm. Therefore, it is recommended to sleep with a towel, a sheet or a blanket wrapping them to be very hot. The next day, get out of bed with slippers and do not step on the floor without them. Until it’s time to shower, do not be barefoot. Your pain will go away after the first treatment. Repeat this procedure every six months or when you feel pain again, and believe me you will be amazed by the results![/su_pullquote]
Alison: Tried this last night but no miracle cure I'm afraid.
Wendy: Be careful with physio pain is coming from spine which should be checked out first
Juliette: Highly recommend pilates or yoga. The stretches can immediately get relief. Osteo is my go to for treatment. Also magnesium and tumeric.
Carole: Magnesium AND... Acupuncture... did it for me... worth a try?
Alison: He's been having accupuncture for over 2 weeks but looking for other possibilities as pain isnt decreasing.
Manasi: Hi Alison, Often it depends on the practitioner of Acupuncture and other modalities, as to how skilled they are. I can highly recommend *** the owner of Body and Soul Oriental Medicine on *** Road. is a full fledged Chinese Medicine Doctor and skilled Acupuncturist. He goes to the root cause of the problem and works very holstically to resolve it He has helped me and I am sure many others. He is ACC registered and would cost only $20 for a session. He spends good 1 hr with you unlike many chiropractors who do a quick 10 min fix. He will also check pulse and tongue. A truly kind, generous, skilled and experienced practitioner.
Anne: Doctors visit first to exclude herniated disc, osteoarthritis or sprained ligament, nerve damage (diabetes), tumour or blood clot. Recommend resting, firm mattress, non-steroidal anti-inflammatories, applying heat or cold, sleeping on his side, knees bent and a pillow between knees sometimes provides relief.
Raewyn: Highly recommend Samineh (Sam) *** at Revolution Chiropractic on *** Road, ***. My lifesaver.
Kath: [Get a] Surgeon referral from your GP so it can get looked into further it maybe a lumber spine disk issue. I am suffering the same pain it is hideous and completely controls you. I havnt been able to work or drive. Mine is a disk issue which was picked up on an MRI. I am on a mixture of meds which takes the edge of some days. Gabapentin is a good med for nerve pain mixed with the usual panadol and brufen. I am on the above as well as tramadol and sevradol. Good luck with it all I can sympathise with you.
Alison: Oh thats awful. We did start with our GP and he just gave painkillers. All the best to you finding relief.
Kath: Alison you need to push it to get answers don’t give up. Unfortunately this is our system. I have been to hospital twice as my pain relief sometimes isn’t enough. I need surgery but have to wait for the hospital system as ACC declined me. I may be able to get it done privately just doing that process now. But I can definitely tell you that you need to keep pushing for answers. Pain is not normal and not ok to live with.
Alison: Thanks so much everyone. We will definitely be trying out some other avenues as per your ideas.
Miranda: Osteopath
Nicole: Dont judge cannabis oil. Its expensive but amazing healing abilities would be good for nerve pain .Our body has its own cannabanoids to heal but over time we need to boost them .I ve heard its healed alot of peoples conditions .maybe google it . Im not a smoker or drug user in anyway .Just sick of putting more prescription pills in the body that simply dont work ..like Lyrica which is for nerve pain with too many side effects .
Camille: Exercises for Lower Back Pain
Kelly: Osteo
Alicia: Ozone therapy
Margo: Although walking is not what he probably feels like doing, it is actually really helpful with both lower back pain and sciatica (I know this from both experience and reading the research). Also, glute and IT band stretches. I would also recommend Dr Stuart McGill - a top researcher on spinal health - his recommended 3 exercises might be helpful (article attached) - Enhancing Low Back Health through stabilization exercise
Lexy: Second osteopath and my favourite stretch for sciatica is sit on the ground with your back hard up against a wall with your legs straight out in front of you. Place you palms on top of tour thighs and flex your toes up. Then, while keeping your back straight, slowly run your hands down over your legs towards your feet toes. He should feel the stretch straight away in his sciatica. Do this whenever needed. Hold the stretch for ten seconds or so and repeat a few times.
Sally: Alison, please don't muck around with trying to find alternative treatment instead of making sure you get a fast referral to either a Neurosurgeon or an Orthopedic surgeon. Did he have an injury that has caused this? I had a prolapsed disc over 30 years ago and doctors were not on the ball and I had over two months of pain etc and ended up with permanent nerve damage. I was eventually referred to a Neurosurgeon who had to untangle the fragments from my prolapsed disc and the main nerve down my spine in an operation. My advice is to ask your husband what pain level he is out of 10, if he is 8 or 9, my advice is to go to A&E tomorrow and do not leave until they have scanned your hubbies back. Xray is pretty useless for disc matter. You are also entitled to a second opinion if you are not getting the answers you should. Feel free to PM me if you want to. I'm serious, don't muck around.
Bianca: Go see Adrian at proactive Physio
Pamela: I had sciatic pain over 4 years ago now but have never had it again after I went to my spinal physio. He gave me a set of stretches to do and I have to do them every day to help my spine and keep sciatica away. They have changed my life completely and 4 yrs later I'm still pain free. pm me if you think the stretches will help I can explain them to you. Otherwise tell him to see a spinal physio x
Nicole: Natural healing has been working for millions of years. While doctors give you prescriptions that may or may not work making drug companies richer. Why not try natural products when so many others fail if it works and is better for you body. So many doctors get it wrong the doctors these days arent like the old days wanting to investigate they are now paid by different drug companys to push certain drugs. Ask your Doctor how medicine now isnt to neccessarily make us well anymore .people are misdiagnosed everyday by Doctors that dont have patients care first anymore. Health systems are failing many people around the world. So why not bring ourselves back to simple remedies that have amazing healing propertys. For instance a friend uses tumeric and black pepper in a smoothie to get tid of menupausal symptoms such as headaches mood swings etc. Egg yolks red onion coconut oil is fantastic for silky soft hair. Coconut oil tumeric paprika egg whites. Vitamin is great for skin. Our bodys for years have been pushed with pills n prescription meds antibiotics etc. So why not try something that could improve our circulation or other ailments. Vinegar for cleaning vanilla essence baking soda for smells it goes on..Many people have lost faith in the medical health system so why not.
Nicole: Capsicum is very potent for nerve pain thats why its in nerve pain cremes another example.
Ashley: Paul Lagerman interesting comments don't you think?
Dominique: Yes I had it bad a few years ago and started yoga the bikram hot yoga I got relief after just a few sessions. Poor hubby.
Dorothea: Look into EFT/tapping. It's a mix of Western psychology and using acupressure meridians/endpoints [link]. Hope you feel better soon
Megan: Nigel *** rd *** $20
Alison: Is this a professional? Business name?
Megan: Alison yes [phone number] can't remember business name he's well known 4 osteo sports massage he's relieved my brother of terrible sciatica pain and myself with aches and pains over the years other people on the Shore know of him as well
Rachael: I have it due to a disk that’s collapsed, I roll up in a ball and bring my knees to my chest twice a day when it’s bad. Physio might help as well.
Kat: I found sitting on a swiss ball instead of an armchair helpful.
Kim: I found Pilates was helpful, I got thought proper technique and exercises from a physiotherapist and was shown what movements to do to help release pressure. But my injury might be different then your husband's. Please go see a specialist before trying anything else. I was referred to my physiotherapist once I had seen a specialist.
Paula: I'm a massage therapist - he needs to get it either massaged, looked at by an Osteopath, or go to his doctor. Stretches and strengthing can really help, he may have a subluxation in his spine or tight muscles/fascia in his hip/glute region pulling or compressing the nerve.
Natasha: Heat and some stretches. I found walking helped.
Some thoughts
It's hard to make generalisable comments on such a small sample of people's opinions, but then I'm not trying to argue that this is either possible or desirable. Rather I think there are some broad impressions that can be drawn from these kinds of events.
If evidence-based practice (EBP) represents the frontline in the efforts by the orthodox profession's to protect and secure our social standing in the eyes of the public, then it doesn't appear to have penetrated into the lives of this group, and I don't believe that they are in any way more or less ignorant, biased or immune to reason than anyone else.
The range of interventions now available to people are bewildering to all but the most informed, and few people have the time to be that well informed. Most people pay only superficial attention.
People reach out to others when they're unwell, and 'likes' on a Facebook feed carry as much, if not more, currency than the supposed wisdom of orthodox health professionals.
People are much more open to alternatives these days. Neoliberal economic reforms have given people more disposable income and most governments have opened up healthcare markets to competition. It is hard to imagine this being reversed in the near future, so competition for the public purse is likely to increase rather than decrease in the years to come.
Research evidence might occupy our waking thoughts, but to Lexy, Margo, Sally and millions of others, it appears to carry almost no weight.
A powerful argument from advocates of EBP may be that this proves the need for a more concentrated focus on EBP because we've clearly failed to get the message across adequately in the past. And this would be a reasonable argument if one believed that EBP could come close to achieving what it promises. The reality is that EBP has done nothing to clarify the marketplace for the treatment of back pain, anxiety and depression, the common cold, chronic breathlessness, or a myriad other common health complaints, and some might argue it has made matters much worse. The reality is that few people now believe that EBP will make anything other than token impact on the lives of real people, who are increasingly at the mercy of too much information and not enough time.
If traditionally orthodox professions like physiotherapy are going to make any significant impact on the public's consciousness in the future, new ways of thinking about our function in society need to be considered, and these surely cannot be found within dogmatic support for EBP.
*In a couple of places I've corrected bad typos to aid with the reading, but otherwise this is a verbatim record. I've only included peoples first names and removed names and addresses to businesses where appropriate.