From the Guidelines
For patients with sciatica pain, clinicians should consider the addition of nonpharmacologic therapy with proven benefits, such as spinal manipulation for acute low back pain, or intensive interdisciplinary rehabilitation for chronic or subacute low back pain, as recommended by the American College of Physicians and the American Pain Society 1.
Treatment Options
- For acute low back pain, spinal manipulation is a recommended nonpharmacologic therapy 1.
- For chronic or subacute low back pain, intensive interdisciplinary rehabilitation is a recommended nonpharmacologic therapy 1.
- Gabapentin is associated with small, short-term benefits in patients with radiculopathy, but has not been directly compared with other medications or treatments 1.
- Herbal therapies, such as devil's claw, willow bark, and capsicum, seem to be safe options for acute exacerbations of chronic low back pain, but benefits range from small to moderate 1.
- Systemic corticosteroids are not recommended for treatment of low back pain with or without sciatica, because they have not been shown to be more effective than placebo 1.
Medication Use
- Benzodiazepines seem similarly effective to skeletal muscle relaxants for short-term pain relief, but are also associated with risks for abuse, addiction, and tolerance 1.
- If a benzodiazepine is used, a time-limited course of therapy is recommended 1.
- Extended courses of medications should generally be reserved for patients clearly showing continued benefits from therapy without major adverse events 1.
From the Research
Treatment Options for Sciatica Pain
- Conservative treatment is often the first approach for managing sciatica pain, with the natural course of the condition seeming to be favorable 2
- Combined conservative interventions, such as exercise therapy and drug therapy, may be effective in reducing pain and disability in people with sciatica, especially in the short and long term 3
- Bed rest and anti-inflammatory drugs, such as buffered aspirin, are commonly recommended for the conservative treatment of acute sciatica 4
- Surgical intervention may be more effective than non-surgical treatment for chronic sciatica-related back pain, but conservative treatment can significantly reduce leg pain and improve mental and physical health outcomes 5
Pharmacological Interventions
- The efficacy and tolerability of drugs commonly prescribed for sciatica, such as non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and antidepressants, are unclear due to the low quality of existing evidence 6
- Corticosteroids and anticonvulsants, such as gabapentin, may show some benefits in reducing pain in the short term, but the evidence is limited 6
- Epidural steroids may be beneficial for subgroups of nerve root compression, but further trials are needed to investigate this treatment option 2
Non-Pharmacological Interventions
- Exercise therapy and physical activity may be beneficial in reducing pain and disability in people with sciatica, especially when combined with other conservative interventions 3
- Low-back school and instruction in low-back hygiene may be helpful in managing sciatica pain and preventing future episodes 4
- Aerobic exercise programs may be encouraged for physically capable patients to improve overall health and well-being 4