Another issue raised by the study of Mathieson and colleagues is the heterogeneity of pain mechanisms in acute or chronic sciatica. In the study of Mathieson and colleagues only 22 to 34 % of the patients had neuropathic pain characteristics based on a validated screening tool (PainDetect). Similarly it has been shown using another screening tool (DN4) that neuropathic and nociceptive components of low back pain varied in the back and lower limb ; in particular the proportion of neuropathic pain seems to be high only in patients with typical dermatomal pain area in the leg but low to very low in other cases (such as for example patients with pain radiation limited to the knee or just below the knee) (J Pain. 2011 ;12 :1080-7). Do you think that such heterogeneity may also explain the lack of effect of pregabalin in sciatica ? Would you treat these patients similarly if their pain was mainly nociceptive ?
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