From the Guidelines
Treatment for sciatic pain typically begins with conservative approaches, including rest, over-the-counter pain medications, and gentle stretching exercises, as recommended by the American College of Physicians and the American Pain Society 1.
Initial Treatment Options
- Start with non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) for 1-2 weeks to reduce inflammation and pain.
- Apply ice packs for 20 minutes several times daily during the first 48-72 hours, then switch to heat therapy.
- Gentle stretches targeting the piriformis muscle, hamstrings, and lower back can provide relief - hold each stretch for 30 seconds and repeat 3 times daily.
Additional Treatment Options
- Physical therapy focusing on core strengthening and proper body mechanics is often beneficial.
- For persistent pain, prescription medications like muscle relaxants (cyclobenzaprine 5-10mg three times daily) or gabapentin (starting at 300mg daily and gradually increasing) may be prescribed.
- Epidural steroid injections can provide temporary relief for severe cases.
- Surgery is typically reserved for cases with significant nerve compression or when conservative treatments fail after 6-12 weeks.
Underlying Causes
Sciatic pain occurs when the sciatic nerve is compressed or irritated, commonly due to herniated discs, spinal stenosis, or piriformis syndrome, which explains why reducing inflammation and pressure on the nerve is the foundation of treatment 1.
From the Research
Treatment Options for Sciatica
The treatment options for sciatica (lumbar radiculopathy) include:
- Topical and oral analgesics, such as opioids, acetaminophen, and non-steroidal anti-inflammatory drugs (NSAIDs) 2
- Ultrasound-guided regional anesthesia, including transgluteal sciatic nerve block and ultrasound-guided peripheral nerve hydrodissection with D5W 2
- Disc surgery, epidural injections, nonopioid analgesia, manipulation, and acupuncture, which have been shown to be effective in improving overall recovery and reducing pain 3
- Phenytoin cream, which has been found to reduce neuropathic pain in patients with sciatic pain due to disc pathology 4
- Gabapentin, which has been used to treat sciatica in patients who are intolerant of other medications or have contraindications for NSAID therapy 5
- Conservative treatment, including bed rest, antiinflammatory drugs, and progressive gradual mobilization, which can be effective in managing acute sciatica 6
Medication Options
Medication options for sciatica include:
- Nonopioid analgesics, such as acetaminophen and NSAIDs 2, 3
- Opioids, although their use is often limited due to adverse events and potential for addiction 2, 3
- Gabapentin, which has been found to be effective in reducing pain in patients with sciatica 5
- Phenytoin cream, which has been found to reduce neuropathic pain in patients with sciatic pain due to disc pathology 4
Alternative Therapies
Alternative therapies for sciatica include: