Table 3:

Recent guideline recommendations for management of radicular pain of the lower back

Management type	Intervention	Size of effect^*	Quality of evidence^*	Endorsement
Management type	Intervention	Size of effect^*	Quality of evidence^*	2016 UK guideline (14)	2017 US guideline (15)
Nonpharmacologic	Exercise v. usual care	Small	Low (3 RCTs)	Yes	Yes
	Multidisciplinary therapy v. usual care	No trials	N/A^†	Yes, if previous treatment not effective or at risk of poor prognosis	Insufficient evidence
	Traction v. other active treatments	No effect	Low (2 RCTs)	Do not offer	Do not offer
Pharmacologic	Diazepam v. placebo	Harm	Low (1 RCT)	No mention	Do not offer
	Systemic corticosteroids v. placebo	No effect	Moderate (6 RCTs)	No mention	Do not offer
	Pregabalin v. placebo	No effect	High^† (1 RCT) (27)	Yes	Insufficient evidence
	Gabapentin v. placebo	Unclear	Very low^† (2 RCTs) (52), (53)	Yes	Insufficient evidence
	Opioids v. placebo	No effect	Low^† (1 crossover study)	Yes, rescue/short-term only	Yes, second-line therapy only if nonpharmacologic therapy fails
	Amitriptyline v. placebo	No trials	N/A^†	Yes	Do not offer
	Duloxetine v. placebo	No trials	N/A^†	Yes	Insufficient evidence
Injection therapy	Epidural steroid injection v. placebo	Small	High^† (23 RCTs) (54)	Yes	No mention
Surgery	Lumbar discectomy v. conservative management	Discectomy associated with faster reduction in pain intensity	Low^† (3 RCTs) (55)	Yes, if nonsurgical treatment failed and radiologic findings are consistent with sciatic symptoms	No mention

Note: GRADE = Grading of Recommendations Assessment, Development and Evaluation, N/A = No evidence from RCTs, RCT = randomized controlled trial.
↵* Based on the 2017 American College of Physicians guideline summary of evidence except where otherwise noted. Comparisons are to placebo, sham treatment, no treatment or usual care, and on short-term pain outcomes.
↵† Our summary of evidence used the GRADE approach.