Talking certainty, uncertainty and EBP with Raymond Ostelo

The Sciatica Podcast

Thanks for reading the 19th edition of my sciatica newsletter. This newsletter tracks my research into all things lumbar radicular pain!

This week I spoke to Professor Raymond Ostelo!

Raymond recently published a fantastic review of the evidence behind the treatment options for sciatica (link should be open access). In our conversation, we talk about the evidence behind the conclusions of his review. I ask Raymond about:

* How much confidence we should have in the evidence around sciatica

* Whether our research methods are sensitive enough to pick up on differences between treatments

* How clinical expertise fits in with evidence based practice

* What study he would conduct if money and recruitment were no object!

* How he thinks two trials he has been involved in - those lead by van Helvoirt and Luijsterburg - should inform our practice

* And more!

I hope you enjoy the podcast.

Other bits and bobs

* I recommend the latest episode of The Back Pain Podcast, a conversation with David Poulter about discs. He describes disc material as being like crab meat with added water…

* I learned a lot from the conversation under this tweet by Luke Murray, asking for advice for his friend with severe acute radicular pain. Here’s some highlights:

It strikes me that a lot of the options for Luke’s friend are based on no research evidence or poor research evidence. In fact, there is high level evidence that says that oral steroids, anti-neuropathics and steroid injection have little meaningful benefit for people with sciatica. But anyone with an ounce of common sense would know that this doesn’t mean these things “don’t work”, and anyone with half a heart would know this doesn’t mean we shouldn’t think about using them. So much of the decisionmaking in this space comes down to clinical experience, knowledge of the mechanisms, and your own philosophical stance on what research evidence *is*. (Which Raymond and I talk about in the podcast!)

* Book update! Here’s a photo the kanban for the book - this is just the first part, “What is Sciatica?” Sticky notes go from the “pending” column to “researching”, then “writing”, then “editing”, then (empty so far!), “done”. (If the photo looks confusing to your eye - the sticky notes are on a mirror!).

So far, I have written 30,000 words of this section. I expect it will get shorter (and better) as I edit and cut. To help me along I have made a contract with my mate Nils where he gets £1,000 from my account if it’s not finished by February 1st… Nils is exactly the kind of person who would happily take my money, so this is a good extra bit of motivation.

But today is Sunday so I’m off to play tennis! As a reward for Houston being near-uninhabitable in the summer, we are enjoying warm, sunny days in November.

Til next time,

Tom

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