From the Research
The initial management for sciatica should focus on conservative measures, including rest for 1-2 days, followed by gradual return to normal activities, along with over-the-counter pain medications, as this approach has been shown to improve symptoms in 80-90% of cases within 4-6 weeks 1.
Key Components of Initial Management
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) are recommended for pain relief and reducing inflammation.
- Acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) can be used if NSAIDs are contraindicated.
- Physical therapy should be initiated within 1-2 weeks, focusing on stretching exercises for the lower back and legs, core strengthening, and proper body mechanics.
- Heat or ice therapy applied for 15-20 minutes several times daily can provide symptomatic relief.
Rationale for Conservative Approach
The conservative approach is supported by the most recent and highest quality study, which found that epidural corticosteroid injections are effective in reducing short-term leg pain and disability, but the effects are small and short-term 1.
Considerations for Further Evaluation
If symptoms persist beyond 6 weeks or worsen, or if there are red flags such as severe or progressive neurological deficits, further evaluation with imaging and specialist referral is warranted.
Additional Treatment Options
Other treatment options, such as gabapentin, may be considered for patients who do not respond to conservative measures, but the evidence for these treatments is limited and more research is needed 2.
Importance of Accurate Diagnosis
It is essential to differentiate between radicular pain and referred pain, as the epidemiology, clinical course, and therapeutic interventions are different for these two conditions 3.