What is the most effective Non-Steroidal Anti-Inflammatory Drug (NSAID) for sciatica?

From the Guidelines

For sciatica pain, ibuprofen (Advil, Motrin) is often considered the best NSAID option, typically taken at 400-800mg every 6-8 hours with food (not exceeding 3200mg daily). Naproxen (Aleve) is another effective choice, taken at 220-500mg twice daily (maximum 1000mg daily), and offers longer-lasting relief requiring fewer doses. These medications work by reducing inflammation around the compressed sciatic nerve, which helps decrease pain and improve mobility.

Key Considerations

• Before prescribing NSAIDs, clinicians should assess cardiovascular and gastrointestinal risk factors 1.
• Clinicians should recommend the lowest effective doses for the shortest periods necessary 1.
• Strategies for minimizing adverse events in higher-risk patients who are prescribed NSAIDs include co-administration with a proton-pump inhibitor 1.

Additional Recommendations

• For optimal results, combine NSAIDs with gentle stretching, proper posture, and applying heat or ice to the affected area.
• If you have stomach, kidney, or heart issues, consider consulting your doctor before using NSAIDs, as they may recommend acetaminophen (Tylenol) instead, which helps with pain but has less anti-inflammatory effect.
• If pain persists beyond 1-2 weeks of NSAID use or is severe, seek medical attention as you may need prescription-strength options or different treatment approaches.

From the Research

NSAIDs for Sciatica

• The efficacy of NSAIDs for pain reduction in sciatica is not significant, with low- to very low-level evidence using the GRADE criteria 2.
• NSAIDs showed a better global improvement compared to placebo, but the level of evidence was low due to small study samples, inconsistent results, imprecision, and a high risk of bias in the included trials 2.
• The risk-benefit ratio of prescribing NSAIDs needs to be considered, as they are frequently prescribed and have an increased risk for side effects in the short-term use 2.

Comparison of NSAIDs with Other Treatments

• Corticosteroids and the anticonvulsant gabapentin showed some benefits in reducing pain in sciatica, but only in the short term 3.
• The efficacy and tolerability of drugs commonly prescribed for the management of sciatica, including NSAIDs, corticosteroids, antidepressants, anticonvulsants, muscle relaxants, and opioid analgesics, is unclear due to low-quality evidence 3.
• For acute low back pain, muscle relaxants and NSAIDs may be superior to placebo for reducing pain, but the effects of opioids, antibiotics, and antidepressants are unknown 4.

Treatment Options for Chronic Low Back Pain

• Over-the-counter analgesics, including NSAIDs and acetaminophen, are the most frequently used first-line medication for low back pain, and current guidelines indicate that they should be the first prescribed treatment for non-specific low back pain 5.
• NSAIDs, antidepressants, and opioids may be superior to placebo for reducing pain in chronic low back pain, but opioids have an established profile of harms 4.
• The effects of paracetamol and muscle relaxants for chronic low back pain were unclear, and they should only be prescribed following a discussion between the treating clinician and the patient, considering the risks and possible benefits 4.