Factors predicting the transition from acute to persistent pain in people with 'sciatica' - the FORECAST study
Lead Research Organisation:
University of Oxford
Department Name: Clinical Neurosciences
Abstract
Sciatica is a term used to describe painful symptoms affecting the hips, buttocks and legs. It is caused by injured or irritated nerves in the lower back. Sciatica pain can feel hot, sharp, or electrical in nature. Sciatica can also cause weakness and pins and needles. Sciatica is a complex condition and the pain may be caused by different mechanisms in different patients. We still do not fully understand the exact mechanisms of sciatica pain.
Sciatica is a very common condition and can have a devastating effect on everyday life. For example, some patients lose their independence and need help with day-to-day tasks such as dressing. Sadly, approximately one in three patients with sciatica develop persistent sciatica pain.
We currently do not understand why some patients develop persistent sciatica pain and why some recover. Previous research has demonstrated that usual clinical findings (e.g., presence of depression or changes on a standard MRI scan) cannot predict persistent sciatica pain. Therefore a different approach is required to identify patients who may develop persistent sciatica pain. This is the goal of the FORECAST study.
Previous studies only included a short clinical examination. Our study is different. We will perform a detailed set of tests (see below). Our ambition is that the detailed tests can predict who will develop persistent sciatica pain. The questions we plan to answer in the FORECAST study are:
1. Can the detailed tests identify patients with similar mechanisms causing their sciatica pain?
2. Which of these detailed tests predict persistent sciatica pain?
The FORECAST study is performed by a team of medical doctors, neuroscientists, statisticians and magnetic resonance imaging (MRI) specialists at Oxford University. The team also includes patient partners. They help us to make sure our study is useful for patients.
We will invite 180 patients with recent onset of sciatica pain (<3 months) to participate in the FORECAST study. At their initial assessment, we will perform the detailed tests. This includes detailed sensory nerve testing (quantitative sensory testing). Quantitative sensory testing evaluates how well patients can feel different stimulations such as cold, warm or pressure. This tells us how well the nerve is working and how sensitive it has become. We will also include a precise set of questionnaires to evaluate the types of pain (e.g., burning or electric shock or achy) and emotional wellbeing. Emotional wellbeing can be affected when a patient has sciatica. For instance, some patients may be anxious or angry, and others may feel lonely and detach themselves from friends and family. We will also take a blood sample to look for signs of inflammation. In some patients we will use specialised MRI scans. These images are much more detailed and specialised than standard MRI scans. They allow us to evaluate the microscopic structure of the small nerves in the back, which is not possible with standard MRI scans. These detailed tests will provide us with a good picture of the starting point of a patient's experience of sciatica.
We will then contact patients again three months and one year later, to ask whether they still have sciatica pain. We will use statistics to identify patients with similar mechanisms causing their sciatica pain. We will also examine which tests predict persistent sciatica pain.
The results of the FORECAST study will help us better understand the complexity of sciatica and who will develop persistent pain. Our findings will also help future research. For example, future studies can examine whether we can prevent or reduce persistent pain by giving more specific treatment to patients who the FORECAST study shows are likely to develop persistent sciatica pain. We hope that the results of the FORECAST study will help reduce suffering and improve quality of life for patients with sciatica.
Sciatica is a very common condition and can have a devastating effect on everyday life. For example, some patients lose their independence and need help with day-to-day tasks such as dressing. Sadly, approximately one in three patients with sciatica develop persistent sciatica pain.
We currently do not understand why some patients develop persistent sciatica pain and why some recover. Previous research has demonstrated that usual clinical findings (e.g., presence of depression or changes on a standard MRI scan) cannot predict persistent sciatica pain. Therefore a different approach is required to identify patients who may develop persistent sciatica pain. This is the goal of the FORECAST study.
Previous studies only included a short clinical examination. Our study is different. We will perform a detailed set of tests (see below). Our ambition is that the detailed tests can predict who will develop persistent sciatica pain. The questions we plan to answer in the FORECAST study are:
1. Can the detailed tests identify patients with similar mechanisms causing their sciatica pain?
2. Which of these detailed tests predict persistent sciatica pain?
The FORECAST study is performed by a team of medical doctors, neuroscientists, statisticians and magnetic resonance imaging (MRI) specialists at Oxford University. The team also includes patient partners. They help us to make sure our study is useful for patients.
We will invite 180 patients with recent onset of sciatica pain (<3 months) to participate in the FORECAST study. At their initial assessment, we will perform the detailed tests. This includes detailed sensory nerve testing (quantitative sensory testing). Quantitative sensory testing evaluates how well patients can feel different stimulations such as cold, warm or pressure. This tells us how well the nerve is working and how sensitive it has become. We will also include a precise set of questionnaires to evaluate the types of pain (e.g., burning or electric shock or achy) and emotional wellbeing. Emotional wellbeing can be affected when a patient has sciatica. For instance, some patients may be anxious or angry, and others may feel lonely and detach themselves from friends and family. We will also take a blood sample to look for signs of inflammation. In some patients we will use specialised MRI scans. These images are much more detailed and specialised than standard MRI scans. They allow us to evaluate the microscopic structure of the small nerves in the back, which is not possible with standard MRI scans. These detailed tests will provide us with a good picture of the starting point of a patient's experience of sciatica.
We will then contact patients again three months and one year later, to ask whether they still have sciatica pain. We will use statistics to identify patients with similar mechanisms causing their sciatica pain. We will also examine which tests predict persistent sciatica pain.
The results of the FORECAST study will help us better understand the complexity of sciatica and who will develop persistent pain. Our findings will also help future research. For example, future studies can examine whether we can prevent or reduce persistent pain by giving more specific treatment to patients who the FORECAST study shows are likely to develop persistent sciatica pain. We hope that the results of the FORECAST study will help reduce suffering and improve quality of life for patients with sciatica.
Technical Summary
Sciatica is a common condition (43% lifetime prevalence) and is associated with higher levels of pain, disability, poorer quality of life, and increased use of health resources compared to low back pain alone. Although many patients recover, a third develop persistent sciatica symptoms. Unfortunately, it remains unclear, why some patients develop persistent sciatica as none of the traditionally considered clinical parameters (e.g., symptom severity, routine magnetic resonance imaging, depression) are consistent prognostic factors. Given the failure of traditional variables as prognostic factors, a novel approach is required to understand who may develop persistent pain.
FORECAST includes a prospective prognostic cohort study that aims to:
1. Explore mechanism-based subgroups in patients with sciatica, using deep phenotyping.
2. Investigate whether a mechanism-based approach can identify factors that predict pain persistence in patients with sciatica.
We will evaluate prognostic factors for pain persistence in n=180 patients with acute/subacute sciatica. Prognostic variables will be assessed at baseline and outcome at 3 and 12 months. This will include self-reported sensory and psychosocial profiles, quantitative sensory testing, blood inflammatory markers and advanced neuroimaging. We will use principal component analysis followed by clustering methods to identify subgroups. Univariate associations and machine learning methods optimised for high dimensional small datasets will be used to identify the most powerful predictors and model selection/accuracy.
This project is based on our strong feasibility data and has been shaped by in-depth patient involvement. The results will provide crucial information about the pathophysiological drivers of sciatica symptoms and identify prognostic factors of pain persistence. This will ultimately facilitate patient stratification and streamline management pathways to increase quality of life for patients with sciatica.
FORECAST includes a prospective prognostic cohort study that aims to:
1. Explore mechanism-based subgroups in patients with sciatica, using deep phenotyping.
2. Investigate whether a mechanism-based approach can identify factors that predict pain persistence in patients with sciatica.
We will evaluate prognostic factors for pain persistence in n=180 patients with acute/subacute sciatica. Prognostic variables will be assessed at baseline and outcome at 3 and 12 months. This will include self-reported sensory and psychosocial profiles, quantitative sensory testing, blood inflammatory markers and advanced neuroimaging. We will use principal component analysis followed by clustering methods to identify subgroups. Univariate associations and machine learning methods optimised for high dimensional small datasets will be used to identify the most powerful predictors and model selection/accuracy.
This project is based on our strong feasibility data and has been shaped by in-depth patient involvement. The results will provide crucial information about the pathophysiological drivers of sciatica symptoms and identify prognostic factors of pain persistence. This will ultimately facilitate patient stratification and streamline management pathways to increase quality of life for patients with sciatica.
Organisations
- University of Oxford (Lead Research Organisation, Project Partner)
- Versus Arthritis (Co-funder)
- UNIVERSITY OF OXFORD (Collaboration)
- University of Dundee (Collaboration)
- Curtin University (Project Partner)
- SUPSI Univ Appl Sci & Arts Italian Switz (Project Partner)
- Ghent University (Project Partner)
- Universitätsklinik Balgrist (Project Partner)
Title | What is sciatica? |
Description | Co-production of educational video explaining what sciatica is to patients. Co-produced with researchers, clinicians and patient partners. |
Type Of Art | Film/Video/Animation |
Year Produced | 2021 |
Impact | over 12k views on Youtube, Lots of positive feedback through social media (e.g., twitter). Clinicians mentioned that they share the video with their patients. |
URL | https://www.youtube.com/watch?v=HJvNBYOKf64&t=20s |
Description | Lead of the sciatica working group commissioned by the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain |
Geographic Reach | Multiple continents/international |
Policy Influence Type | Participation in a guidance/advisory committee |
Title | Sciatica perception questionnaire |
Description | co-produced a new outcome measurement tool with patient partners and researchers to map perceptions of sciatica. |
Type Of Material | Physiological assessment or outcome measure |
Year Produced | 2022 |
Provided To Others? | No |
Impact | questionnaire will be published in our study protocol and we hope it will be implemented by other groups |
Title | composition of joint QST battery for APDP UK |
Description | speaker at QST workshop, which resulted in the composition of a harmonised QST battery that will be used by all consortia/projects across APDP who collect QST data. |
Type Of Material | Physiological assessment or outcome measure |
Year Produced | 2022 |
Provided To Others? | Yes |
Impact | Harmonised QST battery implemented across consortia. |
Description | Collaboration between FORECAST and ALLEVIATE |
Organisation | University of Dundee |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | we will on-board our dataset to the APDP ALLEVIATE hub. |
Collaborator Contribution | the Alleviate hub will curate our FORECAST dataset |
Impact | no output yet |
Start Year | 2022 |
Description | Collaboration between FORECAST and PAINSTORM |
Organisation | University of Oxford |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | collaboration between FORECAST and PAINSTORM based on data sharing and harmonisation of cohorts. Also overlap of PPI activities. |
Collaborator Contribution | collaboration between FORECAST and PAINSTORM based on data sharing and harmonisation of cohorts. Also overlap of PPI activities. |
Impact | Multidisciplinary collaboration, including physiotherapists, neurologists, spinal orthopaedic surgeons, clincial psychologists, bioinformaticians, MR physicists, biomedical scientists, analytical chemists, patient insight partners |
Start Year | 2022 |
Description | Collaboration with APDP PAINSTORM consortium |
Organisation | University of Oxford |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | We have harmonised our cohorts and will share data between the whiplash and PAINSTORM cohorts |
Collaborator Contribution | analysis of blood markers including neurofilament light chain |
Impact | multidisciplinary, including clinicians, bioinformaticians, biomedical scientists and MR physicists. Also including patient insight partners and industrial collaboration. |
Start Year | 2021 |
Description | collaboration between APDP FORECAST and PAINSTORM consortium |
Organisation | University of Oxford |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | The whiplash cohort has been added to the Advanced Pain Discovery Platform funded PAINSTORM consortium. |
Collaborator Contribution | The industry partner of PAINSTORM (Eli Lilly) will provide in-kind provision of neurofilament light chain evaluation in blood of patients after whiplash injury as a marker of neuronal injury. |
Impact | This is an interdisciplinary collaboration involving academia and industry. no outputs as yet, as we are still finalising data collection |
Start Year | 2022 |
Description | Back Pain Podcast |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Podcast on evidence behind the neurological examination and its performance |
Year(s) Of Engagement Activity | 2022 |
URL | https://www.audible.co.uk/pd/Annina-Schmid-Radiculopathy-The-Sensory-Exam-and-What-the-Results-Mean-... |
Description | Invited speaker British Peripheral Nerve Society Annual Meeting |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | invited lecture at BPNS annual meeting. Sparked interesting discussions and networking. |
Year(s) Of Engagement Activity | 2022 |
Description | JOSPT insights podcast |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | podcast on the neurological examination, and how to apply it in clinical settings |
Year(s) Of Engagement Activity | 2022 |
URL | https://open.spotify.com/episode/63ECBpVKy31K60QUak0L4D |
Description | London International Youth Science Forum |
Form Of Engagement Activity | Participation in an open day or visit at my research institution |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Schools |
Results and Impact | organised outreach session on pain and the senses for London International Youth Science Forum. Really good interactive workshop which motivated students to think big in science. |
Year(s) Of Engagement Activity | 2022 |
Description | Symposium presentation at World congress of Pain Toronto |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Other audiences |
Results and Impact | invited symposium presentation at NeuPSIG satellite meeting at IASP world Congress of Pain in Toronto |
Year(s) Of Engagement Activity | 2022 |
Description | invited keynote SBPR |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | invited keynote on heterogeneity of 'sciatica' and the challenges of neuropathic pain. Led to new collaborations, and attraction of a potential PhD student. networking with UK specialists. |
Year(s) Of Engagement Activity | 2022 |
Description | invited keynote at Serbian Pain Congress |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | invited keynote (online) for Serbian IASP chapter conference. received really good feedback from organisers afterwards that talk was very well received, and sparked discussions. |
Year(s) Of Engagement Activity | 2022 |
Description | podcast tete a tete podcast |
Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Public/other audiences |
Results and Impact | invited speaker on tete a tete podcast with Niklaus Haldimann, who interviews interesting people from diverse backgrounds. |
Year(s) Of Engagement Activity | 2022 |
URL | https://podcast-tete-a-tete.podigee.io |