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

Key points

1. 01All 13 participants conceptualised sciatica as a disc compressing a nerve, with little awareness of inflammatory or neuropathic pain mechanisms
2. 02The compression model led patients to view surgery as the only definitive fix and to distrust conservative treatments such as exercise or medication as not addressing the root cause
3. 03Participants whose MRI did not confirm compression felt invalidated and frustrated, with no alternative explanation offered
4. 04Three participants reported suicidal thoughts linked to severe, unrelenting pain that they felt was not taken seriously
5. 05Patients strongly desired credible, visual, early information about their diagnosis and were sceptical of commercially motivated online sources

How it was conducted

Design

Qualitative interview study using semi-structured one-to-one interviews and thematic analysis

Setting

Single NHS musculoskeletal triage service in Wales, UK

Participants

13 adults consecutively recruited with a clinical diagnosis of lumbar radicular pain (LRP), aged 21-76 years, symptom duration 4 months to 40 years

Data collection

Audio-recorded face-to-face interviews (33-64 minutes each), interview guide based on the Illness Perception Questionnaire and Low Back Pain Treatment Beliefs Questionnaire

Analysis

Template analysis using a priori codes from illness dimensions (IPQ) and treatment dimensions (LBP-TBQ), refined iteratively; saturation confirmed after 11-13 interviews

What they found

• Four main themes identified: (1) the illness experience, (2) the concept of sciatica, (3) treatment beliefs, and (4) the desire for credible information
• All 13 participants described sciatica in terms of disc compression trapping or rubbing nerve tissue; no participant incorporated ischaemic mechanisms into their illness model
• Only 1 of 13 participants conceptualised inflammation as sensitising neural tissue rather than simply adding to compression
• 3 of 13 participants expressed suicidal ideation linked to persistent, severe pain
• Participants viewed surgery as a definitive fix, medication and nerve root block as temporary, and exercise as helpful for coping only, not for addressing compression
• When MRI did not confirm compression, participants were left confused and felt their pain was invalidated; none were able to construct an alternative explanatory model
• Interview duration ranged from 33 to 64 minutes (median 45 minutes); participant median age was 53 years and median symptom duration was 9 months

Limitations

• Single recruitment site limits transferability to other healthcare settings or countries
• Small sample of 13 participants, all English-speaking adults from one Welsh NHS board, limits demographic diversity
• Single analyst coded all data, mitigated only by supervisory team discussion rather than independent dual coding
• Member-checking with participants was not performed, so themes were not validated directly by those interviewed

Why it matters

For patients

If you have sciatica, understanding that inflammation and nerve sensitisation - not just compression - can cause your pain may explain why you still hurt even when a scan looks normal.

For clinicians

Routinely asking patients to explain their understanding of sciatica and actively teaching inflammatory and neuropathic mechanisms alongside compression can prevent misaligned treatment expectations and reduce distress when imaging is inconclusive.

For readers

This study reveals a systematic gap between current pain science and what patients are told, suggesting that brief educational interventions targeting the full pathology of radicular pain could improve shared decision-making.