From the Guidelines
Sciatica treatment should begin with conservative approaches, including over-the-counter pain medications, ice or heat therapy, and gentle stretching exercises, before considering more invasive options. The goal of treatment is to reduce inflammation, relieve pressure on the sciatic nerve, and improve quality of life.
Initial Treatment
- Start with over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily) for 1-2 weeks to reduce inflammation 1.
- Apply ice packs for 20 minutes several times daily during the first 48-72 hours, then switch to heat therapy.
- Gentle stretching exercises focusing on the piriformis muscle, hamstrings, and lower back can help relieve pressure on the sciatic nerve.
Physical Therapy and Nonpharmacologic Interventions
- Physical therapy is highly recommended to develop a personalized exercise program 1.
- For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits, such as spinal manipulation, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, yoga, cognitive-behavioral therapy, or progressive relaxation 1.
Pharmacologic Interventions
- For severe pain, your doctor may prescribe muscle relaxants like cyclobenzaprine (5-10mg three times daily) for short-term use, or a brief course of oral steroids like prednisone (starting at 20mg daily, tapering over 5-7 days) 1.
- 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.
Invasive Options
- If pain persists beyond 6-8 weeks despite these measures, epidural steroid injections may provide temporary relief.
- Surgery is typically reserved for cases with significant neurological deficits or pain that doesn't respond to other treatments.
It's essential to note that the treatment of sciatica should be individualized, and the patient's specific condition and response to treatment should guide the choice of interventions.
From the FDA Drug Label
Cyclobenzaprine hydrochloride tablets are indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions Improvement is manifested by relief of muscle spasm and its associated signs and symptoms, namely, pain, tenderness, limitation of motion, and restriction in activities of daily living The answer to Sciatica treatment is that cyclobenzaprine may be used as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions, which may include sciatica.
- Key points:
- Cyclobenzaprine is used for short periods (up to two or three weeks)
- It is used for acute, painful musculoskeletal conditions
- It has not been found effective in the treatment of spasticity associated with cerebral or spinal cord disease 2
From the Research
Sciatica Treatment Options
- The conservative treatment of sciatica typically involves bed rest and anti-inflammatory drugs, with the main goal of reducing pain and inflammation 3
- Epidural corticosteroid injections have been shown to be effective in reducing short-term leg pain and disability in patients with sciatica, although the effects are small and short-term 4, 5
- The use of epidural corticosteroid injections is recommended for subgroups of patients with nerve root compression, such as those with acute sciatica 6
Efficacy of Epidural Corticosteroid Injections
- Studies have shown that epidural corticosteroid injections are probably more effective than placebo in reducing short-term leg pain and disability in patients with sciatica 4
- However, the quality of evidence is at best moderate, and there is uncertainty about the safety of epidural corticosteroid injections due to very low-quality evidence 4
- One study found that epidural steroid injections provide no additional improvement compared to isotonic saline administered epidurally for sciatica 7
Conservative Treatment Approaches
- Conservative treatment approaches, including pharmacological and non-pharmacological treatments, are typically the first treatment options for sciatica, but the evidence to support their use is limited 4
- A systematic review found that neither traction, exercise therapy, nor drug therapy was unequivocally effective in treating sciatica 6
- The authors of the review recommend trials to investigate the effectiveness of conservative treatment options further, especially with regard to patient subgroups 6