From the Guidelines
Treatment for sciatica should begin with conservative measures, including rest, over-the-counter pain medications, and gentle stretching exercises, as these approaches have been shown to provide small to moderate benefits for acute low back pain 1. The goal of treatment is to reduce inflammation and pressure on the sciatic nerve, which is often compressed or irritated due to a herniated disc, bone spur, or spinal stenosis. Some key considerations for treatment include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help reduce inflammation and pain 1.
- Physical therapy focusing on core strengthening and stretches that target the piriformis muscle and hamstrings is often beneficial 1.
- For more severe pain, prescription medications such as muscle relaxants or gabapentin may be prescribed, but their use should be limited due to potential risks and side effects 1.
- Hot and cold therapy can provide temporary relief, with ice applied for 20 minutes several times daily during acute phases, then switching to heat.
- If conservative treatments fail after 6-12 weeks, epidural steroid injections may be considered, but surgery is typically reserved for cases with significant nerve compression or when other treatments have failed. It's essential to note that the evidence for specific treatments for sciatica is limited, and most medication trials have evaluated patients with nonspecific low back pain or mixed populations with and without sciatica 1. Therefore, treatment should be individualized, and patients should be closely monitored for benefits and adverse events. Nonpharmacologic therapies, such as spinal manipulation, exercise therapy, and cognitive-behavioral therapy, may also be considered for patients who do not improve with self-care options 1.
From the Research
Treatment Options for Sciatica
- The treatment for sciatica can be conservative or surgical, depending on the severity and duration of the condition 2, 3.
- Conservative treatment may include exercise therapy, drug therapy, and epidural steroids, although the effectiveness of these treatments is still debated 2, 4, 5.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for sciatica, but studies have shown that they may not be more effective than placebo for pain reduction, although they may provide some global improvement 4, 5.
- Oral steroids have been studied as a potential treatment for acute sciatica, with some evidence suggesting that they may lead to slightly more rapid rates of improvement in pain, mental well-being, and disability scores 6.
Surgical vs. Conservative Management
- For chronic sciatica (>3 months) due to lumbar disc herniation, the decision between surgical and conservative management is complex, and the choice of treatment depends on various factors, including symptom duration and severity 3.
- A systematic review and meta-analysis found that conservative treatment was associated with significant reduction in leg pain and improvement in mental and physical health outcomes, while surgical treatment demonstrated significant improvement in back pain 3.
- The study suggests that conservative treatment may be the initial approach, unless surgery is warranted, particularly in cases with neurological deficits or cauda equina syndrome 3.
Epidural Steroids
- Epidural steroids may be beneficial for subgroups of nerve root compression, and their effectiveness is still being investigated 2.
- Further studies are needed to determine the effectiveness of epidural steroids for sciatica, particularly with regard to patient subgroups, such as those with acute sciatica 2.