Sciatica results when the sciatic nerve is compressed, irritated, or inflamed. The condition may lead to pain and weakness in the back, buttocks and legs. More than 5 million people in the U.S. suffer from sciatica, but unfortunately, there is no guaranteed solution to ensure that these patients are relieved of their pain.
Conventional therapies for sciatica are limited by their side effects and potential lack of effectiveness. While surgery tends to be the last option explored to treat sciatica after less invasive options have failed, the risks associated with painkillers have brought into question whether beginning therapy with opioids makes sense as a conservative intervention for sciatica. Indeed, treating sciatica with opioids has been shown to inadvertently lead to opioid abuse. Just one day of opioid use increases the likelihood that a patient will be taking opioids a year later. According to the National Academies of Sciences, Engineering, and Medicine, there are about 2 million Americans age 12 and over that are addicted to prescription opioids.
West Virginia is a state that is particularly affected by the opioid crisis, and researchers at West Virginia’s University’s Neuroscience Institute are now running a clinical trial on a therapy that could offer a safe alternative to opioid pain killers for those with sciatica. The drug under investigation is called clonidine, and it is administered to patients as a tiny pellet, smaller than the size of a grain of rice, into the lumbar column. More specifically, it is injected into what is called the epidural space in the lumbar section of the back.
A New Alternative
Clonidine is not a new drug. It was initially approved back in the 1970s in the form of a pill to treat hypertension. Since then, clonidine has also been approved for the treatment of severe pain in cancer patients, as well as for attention deficit hyperactivity disorder, or ADHD. By acting as what is known as an alpha-2 agonist, clonidine stimulates alpha-2-adrenergic receptors, including those located in the lower back. Clonidine works to reduce pain through multiple mechanisms. First, it blocks pain signals from reaching the brain, and second, it can interrupt inflammation that contributes to chronic pain.
There will be up to 30 clinical trial sites across the United States recruiting hundreds of patients with sciatica and working to test the potential of the clonidine pellet for treating this disorder. To test the effects of clonidine, half the patients are receiving the clonidine pellet, while the other half is receiving a placebo injection that contains no medicine.
The researchers are also evaluating patients’ pain and disability before treatment as well as 1 day and 30 days following treatment to see how the clonidine treatment compares to no treatment in improving pain and function. The results of this research will help improve our understanding of sciatica and how best to treat it and will hopefully mean that there’s a new, helpful strategy that sciatica patients can use to relieve their pain.