From the Guidelines
Treatment for sciatica should begin 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.
Key Considerations
- For pain relief, start with non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily) 1.
- 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 help relieve pressure on the sciatic nerve.
Nonpharmacologic Therapies
- Spinal manipulation administered by providers with appropriate training is associated with small to moderate short-term benefits for acute low back pain (duration <4 weeks) 1.
- Intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation may be considered for chronic or subacute low back pain 1.
Medications
- Gabapentin is associated with small, short-term benefits in patients with radiculopathy, but has not been directly compared with other medications or treatments 1.
- Benzodiazepines seem similarly effective to skeletal muscle relaxants for short-term pain relief, but are also associated with risks for abuse, addiction, and tolerance 1.
Important Notes
- 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.
- Extended courses of medications should generally be reserved for patients clearly showing continued benefits from therapy without major adverse events 1.
From the Research
Treatment Options for Sciatica
- Conservative treatment is often the first approach for managing sciatica, with the natural course of the condition seeming to be favorable 2.
- The effectiveness of many conservative therapies, such as traction, exercise therapy, and drug therapy, remains controversial and lacks unequivocal evidence of effectiveness 2.
- Epidural steroids may be beneficial for subgroups of patients with nerve root compression, with possible effectiveness for sciatica 2, 3, 4.
Efficacy of Combined Conservative Interventions
- Combined conservative (non-pharmacological) interventions may be more effective than single interventions for reducing back pain and disability in patients with sciatica, particularly in the short and long term 5.
- However, the certainty of evidence is low to moderate, and future studies with more robust methodologies are needed to confirm these findings 5.
Epidural Corticosteroid Injections
- Epidural corticosteroid injections may be effective in reducing short-term leg pain, disability, and overall pain in patients with sciatica, although the effects are small and short-term 3, 4.
- The quality of evidence for the efficacy of epidural corticosteroid injections is moderate, with some uncertainty due to problems with trial design and inconsistency 3.
Surgical vs. Conservative Management
- For chronic sciatica (>3 months) due to lumbar disc herniation, conservative treatment may be associated with significant reductions in leg pain and improvements in mental and physical health outcomes 6.
- Surgical treatment may be more effective than non-surgical treatment for chronic sciatica-related back pain, although conservative treatment is recommended as the initial approach unless surgery is warranted 6.