Open Access

Brigitte Tampin, Schmid, Slater

• Background Pain radiating from the spine into the leg is commonly referred to as ‘sciatica’. ‘Sciatica’ is associated with reduced quality of life, significant suffering and socio-economic burden. The main challenges associated with a diagnosis of ‘sciatica’ relate to the inconsistent use of terminology for the diagnostic labels ‘sciatica’/radicular pain/painful radiculopathy, and the identification of neuropathic pain. These challenges hinder collective clinical and scientific understanding and clarity regarding these conditions, impact effective clinical communication and care planning, prevent clear interpretation of the scientific literature related to the condition, and ultimately may contribute to the limited efficacy and personalisation of care for people living with ‘sciatica’. Aims A working group commissioned by the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain was tasked with the aims: (i) to revise the use of terminology for classifying spine-related leg pain, (ii) to propose a way forward on the identification of neuropathic pain in the context of spine-related leg pain. Method Three facilitators convened an international expert group (n=12; 6 physicians, 5 physiotherapists, 1 patient advocate; specialities in musculoskeletal health, neurology/pain specialist, general practice, neurosurgery) with diverse expertise in the area of ‘sciatica’. A literature review was conducted to propose recommendations on terminology, followed by the first virtual meeting. The second meeting entailed discussions on the application of the neuropathic pain grading system, including the use of patient case studies to test operationalisation of the system. The system had been developed to assist clinicians and researchers in determining whether patients have neuropathic pain and the level of confidence associated with that decision. Patients are classified as having no neuropathic pain, possible, probable or definite neuropathic pain. The working group members were briefed and updated about the progress before, between and after the meetings with summary papers outlining the objectives, tasks and outcomes of each workshop. Results The panel recommended discouraging the term ‘sciatica’ for use in clinical practice and research without further specification of what it entails. The term ‘spine-related leg pain’ is proposed as an umbrella term to include the case definitions of somatic referred pain and radicular pain with and without radiculopathy. Differences in the application of the grading system among panel members and uncertainties to the interpretation of the grading system in the context of spine-related leg pain highlighted the need for further clarifications. The panel proposed an adaptation of the neuropathic pain grading system to facilitate the identification of neuropathic pain in the context of spine-related leg pain. The application of the adapted grading system will be presented at the IFOMT conference. Conclusion The working group recommends discouraging use of the term ‘sciatica’ in clinical practice and research; instead, accurate case definitions should be used. The panel proposed an adaptation of the neuropathic pain grading system in the context of spine-related leg pain, to facilitate the identification of neuropathic pain. Implications These recommendations will facilitate common language in clinical practice and research and assist the initiation of more specific management for this patient population. Funding acknowledgements: IASP NeuPSIG commissioned Working Group