You are a busy clinician working in primary care as a first contact musculoskeletal practitioner. You meet with a 60-year-old lady who has been suffering from recurrent left-sided low back and posterior thigh pain for the last few months. You check her notes and there is mention of sciatica as a diagnosis. In discussion with your patient, she also thinks she has sciatica. To explore this common scenario, the following are some things I would like to discuss in this MSKMag piece:
What does the label sciatica even mean?
Is it always neuropathic?
Could it be somatic-radicular pain?
Could it be something else?
What does the label sciatica even mean?
From a lay perspective, this might seem like an easy question to answer. Sciatica is the pain I am feeling in my leg or the sharp pain in my low back, vaguely reminiscent of a ‘nervy’ issue. A pain problem, at the very least. From a clinical research perspective, however, there is no operational definition for the label sciatica (1). It has been used to denote radicular pain, radiculopathy, somatic-referred pain, and even sacroiliac pain (2). While these presentations can and do co-exist, they represent distinct phenotypes with differing features and differing management approaches (3). Amalgamating these under just one banner (the so-called heterogeneity problem) may serve to hinder clinical and scientific progress. It also makes for vague, potentially unhelpful clinician-to-clinician terminology. The Neuropathic Pain Specialist Interest Group (NeuPSIG) of the International Association for the Study of Pain (IASP) recommends against the use of the term sciatica (1), instead advocating for radicular pain, radiculopathy, and somatic-referred pain to fall under the umbrella term ‘spine-related leg pain’ (1), though I personally prefer ‘low back-related leg pain’ (LBRLP).
Avoid using the term ‘sciatica’ in clinical communications with colleagues, using the terms proposed instead. These terms are not patient-friendly, however. For patients, use simple, plain language like ‘nerve-related’, ‘muscle-related’, or ‘low back-related’ with some explanation. If you use the term ‘sciatica’, contextualise it as a proxy for radicular pain. Consider using an anatomical model to aid understanding.
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