From the Guidelines
For sciatica pain, I recommend starting with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) at 400-600mg every 6-8 hours or naproxen (Aleve) at 220-440mg every 12 hours, always taken with food to protect your stomach. The evidence from 1 suggests that NSAIDs are effective for short-term pain relief in patients with sciatica. Some key points to consider when treating sciatica pain include:
- Acetaminophen (Tylenol) at 500-1000mg every 6 hours is an alternative if you can't take NSAIDs, as seen in 1.
- For more severe pain, your doctor might prescribe muscle relaxants like cyclobenzaprine (5-10mg three times daily) or prescription-strength NSAIDs, as mentioned in 1.
- Some patients benefit from nerve pain medications such as gabapentin (starting at 300mg daily and gradually increasing) or pregabalin (Lyrica), as noted in 1. It's essential to complement medication with gentle stretching, applying heat or ice packs for 15-20 minutes several times daily, and maintaining proper posture. If your pain is severe, persists beyond a week despite medication, or includes symptoms like leg weakness, numbness, or bladder/bowel problems, seek immediate medical attention as these could indicate a more serious condition requiring different treatment, as cautioned in 1.
From the FDA Drug Label
NSAID medicines are used to treat pain and redness, swelling, and heat (inflammation) from medical conditions such as: different types of arthritis menstrual cramps and other types of short-term pain The answer is Naproxen.
- Key points:
- Naproxen is an NSAID medicine.
- NSAID medicines can be used to treat pain.
- Sciatica is a type of pain.
- However, the label does not explicitly mention sciatica, so this answer is based on the general use of NSAIDs for pain. 2
From the Research
Medication Options for Sciatica
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for sciatica, but their efficacy for pain reduction is not significant, with very low-quality evidence showing comparable pain reduction to placebo 3, 4.
- Naproxen, a type of NSAID, has shown small, likely clinically unimportant benefits compared to placebo in patients with moderate-to-severe sciatica 5.
- A network meta-analysis found that subcutaneous anti-tumor necrosis factor-α (anti-TNF-α) and epidural steroid + anesthetic were superior to other treatments for reducing lumbar pain and disability in sciatica patients 6.
- Adding cyclobenzaprine or oxycodone/acetaminophen to naproxen did not improve functional outcomes or pain at 1-week follow-up in patients with acute, nontraumatic, nonradicular low back pain 7.
Considerations for Treatment
- The risk-benefit ratio of prescribing NSAIDs needs to be considered, as they have been found to have a higher risk of adverse effects compared to placebo 3, 4.
- The quality of evidence for the efficacy of NSAIDs in sciatica is generally low to very low, due to small study samples, inconsistent results, and high risk of bias in included trials 3, 4.
- Treatment options should be carefully evaluated and individualized based on patient needs and medical history.
Adverse Effects and Safety
- NSAIDs have been found to have a higher risk of adverse effects compared to placebo, including gastrointestinal and cardiovascular events 3, 4.
- The safety outcome rankings for intravenous and subcutaneous anti-TNF-α were medium to high, indicating a need for careful consideration of potential risks and benefits 6.