What are the causes of sciatic nerve pain?

From the Guidelines

Patients with sciatic nerve pain should be advised to remain active and informed about effective self-care options, as the prognosis for acute low back pain with or without sciatica is generally favorable, with a high likelihood for substantial improvement in the first month. When managing sciatic nerve pain, it is essential to consider the clinical correlation between symptoms and radiographic findings, as well as the severity of symptoms, patient preferences, and surgical risks 1. Some key points to consider in the management of sciatic nerve pain include:

• Providing patients with evidence-based information on low back pain, including the expected course and effective self-care options 1
• Advising patients to remain active, as this is more effective than resting in bed for patients with acute or subacute low back pain 1
• Recommending self-care education books based on evidence-based guidelines, such as The Back Book, to help patients manage their condition 1
• Considering the use of magnetic resonance imaging (MRI) or computed tomography (CT) scans to evaluate patients with persistent back and leg pain who are potential candidates for invasive interventions, while being aware that findings on these imaging tests are often nonspecific 1. It is crucial to prioritize a patient-centered approach, taking into account the individual's preferences, values, and comorbid conditions when making treatment decisions for sciatic nerve pain.

From the Research

Sciatic Nerve Pain Management

• The management of sciatic nerve pain involves various pharmacological interventions, including analgesic and adjuvant pain drugs 2.
• A systematic review and meta-analysis of randomized controlled trials found that the evidence for the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antidepressants, anticonvulsants, muscle relaxants, and opioid analgesics in managing sciatica ranged from moderate to low quality 2.
• Some studies have shown that combination drug therapy may provide greater pain relief and/or improved tolerability compared to monotherapy or placebo 3.

Efficacy of Specific Treatments

• Corticosteroids have shown some benefits in reducing sciatic nerve pain in the short term, with a mean difference in overall and leg pain of -12.2 (95% confidence interval -20.9 to -3.4) 2.
• The anticonvulsant gabapentin has also shown some benefits in reducing chronic sciatica pain, with a mean difference in overall pain relief of -26.6 (95% confidence interval -38.3 to -14.9) 2.
• Combination therapy with buprenorphine and pregabalin has been found to have a clinically important difference in reducing chronic back pain at immediate and short terms, but the quality of evidence is low 3.

Adverse Events

• The median rate of adverse events for active drugs was 17% (interquartile range 10-30%), compared to 11% (3-23%) for placebo 2.
• Combination drug therapy has not been found to have a statistically significant increased risk of serious adverse events, but the risk of adverse events was found to favor monotherapy or placebo in some cases 3.