From the Guidelines
Clinicians should provide patients with evidence-based information on low back pain, advise patients to remain active, and provide information about effective self-care options. When treating acute lumbago with sciatica, it is essential to prioritize a combination of education, self-care, and gentle movement over prolonged bed rest or immediate invasive interventions 1. The treatment approach should include:
- Providing patients with information on the generally favorable prognosis of acute low back pain with or without sciatica, including a high likelihood for substantial improvement in the first month 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 educate patients on effective self-management strategies for nonspecific low back pain 1
- Considering over-the-counter pain relievers and gentle stretching exercises for the lower back and hamstrings to help manage symptoms
- Avoiding early, routine imaging and other tests unless necessary, as they usually cannot identify a precise cause and do not improve patient outcomes 1
It is crucial to note that findings on MRI or CT, such as bulging disc without nerve root impingement, are often nonspecific, and decisions regarding invasive interventions should be based on the clinical correlation between symptoms and radiographic findings, severity of symptoms, patient preferences, surgical risks, and costs 1. If symptoms do not improve within 6-8 weeks, or if severe pain, numbness, weakness, or bladder/bowel dysfunction occurs, immediate medical attention is necessary to rule out more serious conditions requiring specialized intervention.
From the Research
Treatment Options for Acute Lumbago with Sciatica
- Non-steroidal anti-inflammatory drugs (NSAIDs) are often used in the treatment of acute low back pain, including lumbago with sciatica 2, 3, 4, 5, 6
- There is moderate quality evidence that NSAIDs are slightly more effective in short-term reduction of pain intensity than placebo, but the magnitude of the effects is small and probably not clinically relevant 2
- Topical NSAIDs are recommended for non-low back, musculoskeletal injuries, but their effectiveness for lumbago with sciatica is not well established 3
- Acetaminophen is well tolerated and can be used as a first-line treatment option for acute mild to moderate pain, but its effectiveness for lumbago with sciatica is not well established 3, 5
- Selective cyclooxygenase-2 NSAIDs are a more expensive treatment alternative and are used to avoid the gastrointestinal adverse effects of nonselective NSAIDs, but their effectiveness for lumbago with sciatica is not well established 3, 6
Efficacy of NSAIDs for Sciatica
- There is very low-quality evidence that the efficacy of NSAIDs for pain reduction is comparable with that of placebo for sciatica 4
- There is low-quality evidence that NSAIDs are better than placebo for global improvement in patients with sciatica 4
- There is low-quality evidence that the risk for adverse effects is higher for NSAID than placebo in patients with sciatica 4
Adverse Effects of NSAIDs
- There is very low quality evidence of no clear difference in the proportion of participants experiencing adverse events when using NSAIDs compared to placebo for acute low back pain 2
- There is low-quality evidence that the risk for adverse effects is higher for NSAID than placebo in patients with sciatica 4
- NSAIDs should be used with caution in patients with a history of gastrointestinal bleeding, cardiovascular disease, or chronic renal disease 3, 6