This project aims to investigate the effects of oral glucocorticoids in people with acute sciatica. There is currently no simple, effective treatment to relieve the pain in acute sciatica. Acute sciatica is a prevalent, debilitating pain condition. Preliminary evidence suggests that taking oral glucocorticoids may relieve pain and improve function in acute sciatica. The OASIS clinical trial will evaluate whether oral glucocorticoids are effective and safe compared to placebo. The medication will be taken for up to 2 weeks. Participants will be followed up for one year to measure leg pain intensity and other important outcomes. We will also assess drug safety and evaluate cost-effectiveness. This trial is now recruiting. The research team is also looking for General Practitioners who are interested in research to be involved with the recruitment of patients with sciatica into the OASIS study. For more information, please contact: Giovanni Ferreira e: giovanni.ferreira@sydney.edu.au The sponsor of this trial is The University of Sydney. OASIS is funded by the National Health and Medical Research Council. Principal Investigator: Professor Christine Lin (IMH) Chief Investigators: Professor Andrew McLachlan (University of Sydney), Professor Jane Latimer (IMH), Dr Christina Abdel Shaheed (IMH), Qiang Li (The George Institute) Associate Investigators: Dr Bethan Richards (IMH), Professor Rachelle Buchbinder (Monash University), Professor Chris Maher (IMH), Professor Ric Day (University of NSW).

EPIK will investigate the effectiveness, cost-effectiveness, and safety of a model of care to manage patients with persistent pain after total knee replacement (TKR). TKR is used to treat severe osteoarthritis & is one of the most common & expensive procedures performed in Australia. There is no established model of care to effectively manage patients with persistent pain after TKR in Australia, which affect up to 25% of those who undergo TKR. Many of these patients slip through the cracks & are left without options. We propose a new model of care (EPIK) to address this unmet need. EPIK combines i) routinely collected data from a national joint registry which will act as a 'safety net' for patients with persistent pain following TKR; and ii) early assessment and care coordination by a physiotherapist to ensure patients get the right care at the right time. EPIK is funded by the NHMRC and a Ramsay Hospital Research Foundation

Sciatica affects many Australians every year, and half of the people who develop sciatica report having persisting pain of at least moderate intensity after 1 year. There are no simple, readily available treatments for patients with chronic sciatica. Identifying a simple low-cost treatment for chronic sciatica would be a major advance in the field. We have shown that the antidepressant duloxetine is a promising, accessible, low-cost treatment for chronic sciatica. However, the is considerable uncertainty about its efficacy. We will conduct the DREAM trial, which will provide a definitive answer about the efficacy duloxetine for chronic sciatica. Participants randomised to the active arm of the study will receive a 12-week course of oral duloxetine followed by a 2-week tapering phase. The starting dose will be 30 mg/day for 1 week (one 30 mg capsule per day), increasing to 60 mg/day for 11 weeks (maintenance phase – two 30 mg capsules per day). In the 2-week tapering phase, they will receive 30 mg/day (one 30 mg capsule per day) for 2 weeks before treatment is discontinued. Study doctors will be allowed to make modifications to the treatment regimen if required. Participants in this group will also receive guideline-recommended advice (eg NICE). Adherence to study medication will be measured by participants’ self-report of daily medication intake, recorded in a diary or online, and by counting the returned medications, against the study doctor’s prescription record.