From the Guidelines
Management of sciatica should prioritize nonpharmacologic therapies with proven benefits, such as spinal manipulation for acute low back pain and intensive interdisciplinary rehabilitation for chronic or subacute low back pain, as recommended by the American College of Physicians and the American Pain Society 1.
Key Management Options
- For acute low back pain, spinal manipulation administered by providers with appropriate training is associated with small to moderate short-term benefits 1.
- For chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation may be considered 1.
- Medications such as NSAIDs, acetaminophen, and short-term opioids or muscle relaxants may be used for pain control, but their benefits and risks should be carefully weighed, and extended courses of medications should generally be reserved for patients clearly showing continued benefits from therapy without major adverse events 1.
Important Considerations
- 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.
- Patients should be educated about proper ergonomics and body mechanics to prevent recurrence once symptoms improve.
- Surgical intervention, typically microdiscectomy, should be considered for patients with progressive neurological deficits, cauda equina syndrome, or pain that remains severe despite 6-12 weeks of conservative treatment.
From the Research
Management Options for Sciatica
The management options for sciatica include a variety of approaches, ranging from conservative treatments to surgical interventions. Some of the key management options are:
- Conservative management: This approach typically involves advice to stay active, structured exercise, and the use of analgesic and adjuvant pain drugs 2, 3, 4.
- Physiotherapy interventions: These interventions are often prescribed as first-line treatment for people with sciatica, but their effectiveness remains controversial 5.
- Surgical intervention: This approach may be considered for chronic sciatica, particularly in cases with neurological deficits or cauda equina syndrome 6.
Conservative Management
Conservative management of sciatica usually includes interventions to promote physical activity, such as advice to stay active or exercise. The evidence suggests that exercise provides small, superior effects compared with advice to stay active on leg pain in the short term for patients experiencing sciatica 2. Additionally, analgesic and adjuvant pain drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs), may be used to manage pain and disability 3, 4.
Physiotherapy Interventions
Physiotherapy interventions are commonly used to treat people with sciatica, but the evidence on their effectiveness is limited. A systematic review and meta-analysis found that physiotherapy interventions were not significantly more effective than control interventions for pain and disability in people with sciatica 5.
Surgical Intervention
Surgical intervention may be considered for chronic sciatica, particularly in cases with neurological deficits or cauda equina syndrome. A systematic review and meta-analysis found that surgical treatment was associated with significant improvement in back pain, while conservative treatment was associated with a significant reduction in leg pain and improvement in mental and physical health outcomes 6.
Comparison of Management Options
The choice of management option for sciatica depends on various factors, including the severity and duration of symptoms, as well as the presence of neurological deficits or other complications. The evidence suggests that conservative management, including advice to stay active and physiotherapy interventions, may be effective for managing sciatica in the short term, while surgical intervention may be considered for chronic cases or those with significant neurological deficits 2, 5, 6.