Understanding sciatica: Illness and treatment beliefs in a lumbar radicular pain population. A qualitative interview study

Abstract

Background: Several pathological processes contribute to lumbar radicular pain (LRP), commonly known as sciatica. It is not known how patients rationalise the experience of sciatica or understand the diagnosis. Providing clinicians with a better understanding of how patients conceptualise sciatica will help them to tailor information for patients on the management and treatment of the condition. Aim: To understand patients' beliefs regarding their illness following a diagnosis of LRP, how these beliefs were developed, and the impact of illness beliefs on treatment beliefs. Design & setting: Qualitative interview study from a single NHS musculoskeletal interface service (in Wales, UK). Method: Thirteen patients recently diagnosed with LRP were consecutively recruited. Individual semistructured interviews were recorded and transcribed. Data were analysed using a thematic approach. Results: Four main themes were generated: (1) the illness experience (2) the concept of sciatica, (3) treatment beliefs, and (4) the desire for credible information. Conclusion: The diagnosis of LRP is often communicated and understood within a compressive conceptual illness identity. Explaining symptoms with a compressive pathological model is easily understood by patients but may not accurately reflect the spectrum of pathological processes known to contribute to radicular pain. This model appears to inform patient beliefs about treatments. Clinicians should take care to fully explain the pathology prior to shared decision-making with patients.