Tricky clinical questions with Mark Laslett

The Sciatica Podcast

Thanks for reading the 17th edition of my sciatica newsletter. This newsletter tracks my research into all things lumbar radicular pain!

For this week’s podcast I spoke to Mark Laslett! Here’s the timestamps for our conversation, with some links to one or two papers Mark mentions:

1:38: On somatic referred pain.

2:40: “Do you have a theory of what's going on when someone has radicular pain but their MRI does not show anything to explain it?”

7:11: “Does largely compressive radicular pain have a different clinical picture to largely chemical?”

12:10: The role of injections in the wider treatment plan. Mark refers to this study.

16:20: Using screening questionnaires.

19:25: Mark's approach to practice and different treatment modalities.

24:50: How treatment of radicular pain has changed over time, the natural time course of radicular pain and speed of onset as a predictor of recovery.

30:44: “Is there a role for exercise in treating someone whose radicular pain does not centralise?”

33:33: “Are there any long term restrictions on movement after radicular pain has settled? And for squatting and deadlifting specifically?” Mark refers to this paper.

39:39: The role of anti-neuropathic pain medications.

43:40: Coming changes to Mark's online course and treating low back pain when research and guidelines feel vague

Thanks to Mark for taking the time to talk. I sent him a list of questions ahead of time but it got lost in an email thread so he didn’t see it. When we realised this before recording, he said “Well if I needed to prepare to answer your questions, I shouldn’t be answering your questions!”. What a pro!

Other bits and bobs

* I was mortified to notice I’d commited a typo in the *title* of last week’s newsletter. But, no one noticed… right?

* Tina has updated her already-brilliant website Living Well With Pain so now it’s even better. Great, practical information for patients and clinicians on sciatica, in particular persistent sciatica.

* Here’s another really impressive spinal cord prosection

* A new RCT by Julie Fritz and colleagues randomized 220 people with sciatica to receive usual care or usual care with four additional sessions of physical therapy. After six months, the early physical therapy group had an average 5.4 points better score on the Oswestry and an average 1 point less back pain - differences of debateable clinical importance. There was no average difference in leg pain.

Unfortunately, I cannot access the full paper yet so I don’t know what the PT consisted of, or what they classed as sciatica etc. But the results seem disappointing although not that surprising. I think it’s really valuable to get an idea of how much PT treatment affects radicular pain so that we can decide how best to spend our time with patients and advise them on what to expect.

Incidentally, the paper seems to be a very similar design to an older paper by Luijsterburg et al., and both found that patients getting extra PT reported greater treatment success but that their symptoms weren’t that different.

* Here’s my chat with Jack Chew, talking about research (maybe not much new to readers of this newsletter) and from 18 minutes on I pretend I have it all figured out when it comes to social media and news consumption.

Til next time!

Tom

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