Treatment Choices and Healthcare Services Utilization Amongst Lumbosacral Radiculopathy Patients: Results from a Randomized Controlled Trial

Abstract

Lumbosacral radicular pain (LRP) is a common sequelae of low back pain, the world's leading cause of years lived with disability. LRP typically causes numbness, weakness, and tingling into the lower extremity and is associated with high rates of pain and impaired function. Despite its prevalence, there is significant heterogeneity among clinical practice guidelines for the treatment of LRP, which may contribute to poor patient outcomes. The aim of the present study was to identify treatments that participants had previously attempted before enrolling in a randomized controlled trial of a mindfulness-based intervention. This analysis evaluated prior pharmaceutical use, procedures, and non-pharmacologic treatments, with a special focus on complementary and integrative health (CIH) utilization. The data for the present analysis were taken from the health history form of the baseline visit for the randomized controlled trial by Wexler et al 2024. Treatment utilization was evaluated and reported using descriptive characteristics. In this sample of chronic LRP patients (n = 71), we found a high proportion of CIH utilization, including acupuncture (58%), chiropractic care (58%), and herbs/supplements (42%). Most patients (52%) were utilizing two or more CIH modalities to manage their pain. A high percentage of participants had also previously used non-steroidal anti-inflammatories (61%) to manage their pain, and over a third of participants had previously undergone an epidural steroid injection (34%). In our trial, CIH utilization was much higher for treatments like chiropractic care, acupuncture, natural products, and physical activity than has been reported in previous large datasets of patients with chronic pain such as the National Health Interview Survey. Collecting data on CIH utilization in clinical trials can enable researchers to compare their samples to large national datasets and identify differences in use among specific populations. In addition, healthcare utilization data collected in clinical trials can further inform the development of clinical practice guidelines.

Keywords: Back pain; mindfulness; non-pharmacologic management; radiculopathy.