What is the best relief for an acute sciatica (inflammation of the sciatic nerve) attack?

From the Guidelines

For acute sciatic nerve pain relief, the most effective approach is to start with nonpharmacologic therapy, such as spinal manipulation, and consider the addition of over-the-counter pain medications like ibuprofen or naproxen, as well as heat therapy and gentle stretching exercises, as recommended by the American College of Physicians and the American Pain Society 1.

Key Recommendations

• Start with nonpharmacologic therapy, such as spinal manipulation, which has been shown to have small to moderate short-term benefits for acute low back pain 1
• Use over-the-counter pain medications like ibuprofen (400-800mg every 6-8 hours) or naproxen (220-500mg every 12 hours) to reduce inflammation and pain
• Apply heat therapy using a heating pad or warm bath for 20 minutes several times daily, which has been shown to moderately improve pain relief and disability 1
• Gentle stretching exercises like the knee-to-chest stretch or lying spinal twist can help relieve pressure on the nerve
• Maintain proper posture and avoid prolonged sitting or activities that worsen pain
• Light walking may help reduce inflammation and promote healing

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
• Benzodiazepines and gabapentin are not FDA-approved for treatment of low back pain and should be used with caution, as they are associated with risks for abuse, addiction, and tolerance 1
• Herbal therapies, such as devil's claw, willow bark, and capsicum, may be safe options for acute exacerbations of chronic low back pain, but benefits range from small to moderate 1

From the Research

Relief for Acute Sciatic Nerve Attack

• The best relief for an acute sciatic nerve attack is not clearly established due to the low quality of existing evidence from clinical trials 2.
• Non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants may be superior to placebo for reducing pain in acute low back pain, but the effects of opioids, antibiotics, and antidepressants are unknown 3.
• Corticosteroids have shown some benefits in the short term for sciatica, with a mean difference in overall and leg pain of -12.2 2.
• The addition of cyclobenzaprine or oxycodone/acetaminophen to naproxen did not improve functional outcomes or pain at 1-week follow-up in patients with acute low back pain 4.
• NSAIDs may have a role in managing acute and chronic low back pain, but should be used with caution in people who may be at greater risk of experiencing adverse events 3.

Medication Options

• NSAIDs: may be effective for reducing pain in acute and chronic low back pain, but should be used with caution 2, 3.
• Muscle relaxants: may be effective for reducing pain in acute low back pain, but the effects are unknown for chronic low back pain 3.
• Corticosteroids: may be effective in the short term for sciatica, but the long-term effects are unknown 2.
• Opioids: may be effective for reducing pain in chronic low back pain, but have an established profile of harms and should be used with caution 3.
• Antidepressants: may be effective for reducing pain in chronic low back pain, but should be used with caution and only after discussing the risks and benefits with the patient 3.