Back pain, comorbidities and interventions for sciatica

Abstract

This thesis begins with an overview of low back pain and sciatica epidemiology, including their characteristics, potential consequences, and management options. Additionally, twin studies are introduced and described as an emerging field of the genetic influence on spinal pain, with this methodology potentially providing more valid associations than traditional observational studies. The paucity of randomised controlled trials for low back pain within a twin population is also explored. The thesis concludes with a summary of findings and possible implications. The efficacy of interventions for sciatica is investigated in two systematic reviews, with the first review highlighting the superior, short-term effects for surgery over physical activity interventions, however these superior effects diminishing over time. The second review showed that structured exercise was superior to advice to remain active in the short-term management of sciatica, but no differences were observed in the long-term. In addition to these reviews, a short, structured commentary of a review of acupuncture is presented and showed potential for the effective management of sciatica. This thesis also utilised a discordant twin study design, enabling the examination of possible causal relationships between low back pain and various comorbidities, including early mortality. Although small associations were found between chronic low back pain and coronary heart disease, depression or anxiety symptoms in middle-aged twins, a causal path could not be elucidated. Despite an association, no causal link between spinal pain and early mortality (including cardiovascular-specific mortality) could be established in older twins aged ≥ 70 years. Finally, conducting a pilot randomised control trial within a twin study setting for the management of low back pain via sleep improvement is feasible; however lessons learnt during study recruitment and implementation suggest that modifications are required.