Journal Club Summary

Methodology: 3.5/5
Usefulness: 4/5

Mathieson S, et al. N Engl J Med. 2017 Mar 23;376(12):1111-1120.

 Question and Methods:

Double blind, randomized control trial comparing pregabalin against placebo for reducing leg pain symptoms at 8 weeks in 209 patients with acute and chronic sciatica.

Findings: The authors found a between group difference in leg pain reduction of 0.5, with a prespecified difference of 1.5 between groups at 8 weeks.

Limitations: The study grouped both acute and chronic pain presentations, potentially obscuring any possible effect in the acute group.

Interpretation: What does this paper mean for our practice? This paper provides no evidence in support of the practice of prescribing pregabalin to patients with sciatica with some evidence of harm from side effects.

By: Dr. Nick Schouela

 

Epi Lesson  

Pragmatic vs. Explanatory RCTs  
Explanatory randomized controlled trials are those conducted under idealized conditions where inclusion and exclusion criteria are strict to create homogeneous populations and evaluate efficacy of an intervention. Pragmatic trials are more “real-life”, aim to determine effectiveness and consider outcomes which are of most interest to patients.

ByDr. Lisa Calder 

 

Hans Rosenberg
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.