From the Guidelines
Acute sciatica treatment should prioritize conservative measures, including rest, gentle activity, and over-the-counter pain medications, as these approaches have been shown to provide small to moderate benefits for acute low back pain 1. When considering treatment options for acute sciatica, it is essential to weigh the potential benefits and risks of various interventions.
- Conservative measures, such as rest for 1-2 days, followed by gentle activity as tolerated, are recommended as the initial approach.
- Over-the-counter pain medications like ibuprofen (400-800mg every 6-8 hours) or naproxen (220-500mg twice daily) with food can help reduce inflammation and pain.
- Acetaminophen (500-1000mg every 6 hours) can also help with pain but does not address inflammation.
- Apply ice packs for 15-20 minutes several times daily for the first 48-72 hours, then switch to heat therapy.
- Gentle stretching exercises for the lower back and hamstrings can provide relief once the severe pain subsides. It is crucial to note that systemic corticosteroids are not recommended for treatment of low back pain with or without sciatica, as they have not been shown to be more effective than placebo 1. If pain is severe, prescription medications may be needed, such as muscle relaxants like cyclobenzaprine (5-10mg three times daily) for up to two weeks. Physical therapy focusing on core strengthening and proper body mechanics is beneficial for preventing recurrence. Most sciatica cases resolve within 4-6 weeks with these approaches. If symptoms persist beyond 6-8 weeks, worsen significantly, or include bladder/bowel dysfunction or progressive weakness, seek immediate medical attention as these may indicate a need for imaging studies or more aggressive interventions like epidural steroid injections or, rarely, surgery.
From the Research
Acute Sciatica Treatment Options
- Epidural corticosteroid injections: probably more effective than placebo in reducing short-term leg pain, short-term disability, and may be slightly more effective in reducing short-term overall pain 2
- Non-steroidal anti-inflammatory drugs (NSAIDs): low- to very low-level evidence for pain reduction, with some studies showing no significant difference between NSAIDs and placebo 3
- Oral steroids: early administration may lead to slightly more rapid rates of improvement in pain, mental well-being, and disability scores, but has no significant effect on most parameters studied 4
Efficacy of Different Treatments
- Corticosteroids: pooled results of two trials showed some benefits in reducing overall and leg pain, but only in the short term 5
- Gabapentin: a single trial showed some benefits in reducing overall pain relief in chronic sciatica, but only in the short term 5
- Epidural steroid injections: superior to epidural placebo at 6 weeks and 3 months for leg pain and at 6 weeks for functional status, but the minimally clinical important difference (MCID) was not met 6