Reasons for rheumatology department admission in 125 patients with disk-related sciatica

Objectives. To identify medical and nonmedical reasons for admission of dis k-related sciatica patients. Patients and methods. 125 patients were evalua ted prospectively using a 25-items questionnaire, including seven items on medical reasons, four on psychological reasons, four on work-related reason s, six on social and family reasons, and four on miscellaneous reasons. Res ults. Severe nerve root pain (34%), motor loss (17%), atypical clinical man ifestations (13%), severe low back pain (8%), and/or sphincter dysfunction (4 %) were recorded In only 55% of patients, and only 16 % had at least two of these reasons, A minority of patients were admitted to avoid premature surgery (13%) or to try one more conservative approach prior to surgery (15 %). Seventy-five per cent of patients reported at least one of the psycholo gical reasons listed in the questionnaire (irritability/fatigue, 66%; anxie ty, 42%: depression, 26%; panic disorder, 21%), 50% reported at least one w ork-related reason (workaholism, 21%; job offer, 16%; self-employed, 14%; f ear of losing their job, 11%), 66% reported at least one social or family r eason (living alone, 34%; one or more dependents younger than seven years o f age, 32%; too many demands from household members, 22%; one or more depen dents older than seven years of age, 8%: need to care for another person, 9 %; important upcoming family or personal event, 6%), and 26% reported at le ast one miscellaneous reason (firm belief that sciatica can be cured only b y inhospital treatment, 10%; desire to put pressure on the employer or on a n expert, 7% and 6%, respectively; admission via the emergency room without prior medical advice, 6%). Conclusion. In France, the reason for admission of patients with disk-related sciatica is frequently a mixture of physical , psychological, and social problems, with only 55% of patients having a sy mptom requiring inhospital management.