Patient Teaching for Sciatica Pain

Teach patients to remain active and avoid bed rest, as staying active is significantly more effective than resting for managing sciatica. 1, 2

Core Educational Messages

Emphasize that bed rest worsens outcomes through deconditioning and should never be recommended for more than brief periods if absolutely necessary. 1, 2
Instruct patients to continue normal daily activities as much as tolerable, even with pain present. 1, 2
Explain that movement promotes healing and prevents the development of chronic disability. 1
If severe symptoms require brief rest, teach patients to return to activity within 1-2 days maximum. 1

Explain that sciatica is pain radiating down the leg below the knee, typically caused by nerve root compression from disc herniation. 1, 3
Reassure patients that the natural course is favorable - most pain and disability improve within 2-4 weeks with or without treatment. 4
Teach that disc herniations can heal without surgery in the majority of cases. 5
Clarify that imaging findings like bulging discs often don't correlate with symptoms and shouldn't drive treatment decisions. 2

Instruct patients to apply heating pads or heated blankets for short-term pain relief (effective at 4-5 days). 1, 2
This is a safe, evidence-based intervention patients can use at home immediately. 1

Teach patients that NSAIDs (ibuprofen, naproxen) provide small but meaningful pain reduction and are first-line medications. 2
Instruct to use the lowest effective dose for the shortest duration due to gastrointestinal, cardiovascular, and kidney risks. 2
Acetaminophen is an alternative for those who cannot take NSAIDs, though slightly less effective. 1
Warn patients that systemic corticosteroids (prednisone) are NOT effective - multiple trials show no benefit over placebo. 1, 2

Teach patients that supervised, individually-tailored exercise programs become beneficial after the acute phase (2-6 weeks). 2, 5
Explain that symptom-guided exercises - where movements are adjusted based on whether leg pain increases or decreases - are superior to general exercises. 5
Instruct patients to reduce activity temporarily if leg pain worsens, but not to stop moving entirely. 5

Teach patients to seek emergency care immediately for:

Explain that fear-avoidance beliefs (fear that movement will cause harm) are stronger predictors of poor outcomes than physical findings. 2, 3
Teach cognitive-behavioral strategies to overcome unhelpful beliefs about pain and activity. 1, 5
Reassure patients that staying active will not cause permanent damage, even if temporarily uncomfortable. 5

Most patients improve significantly within 2-4 weeks. 4
If symptoms persist beyond 6-8 weeks despite conservative treatment, additional interventions like physical therapy, acupuncture, or specialist consultation may be warranted. 1, 2
Surgery is rarely needed and should only be considered after 6-8 weeks of failed conservative management, except for emergency red flags. 2

Teach that routine X-rays or MRIs are not helpful in the first 4-6 weeks unless red flags are present. 2
Explain that imaging often shows abnormalities that don't correlate with symptoms and can lead to unnecessary worry or interventions. 2

Provide written materials like "The Back Book" as a supplement to verbal teaching. 1, 3
These materials should cover anatomy, pain mechanisms, and reassurance about natural healing. 5

Never tell patients to rest in bed - this is the single most harmful recommendation. 2
Don't overemphasize imaging findings, as they poorly correlate with clinical outcomes. 2
Avoid suggesting that pain means tissue damage is occurring with activity. 5
Don't recommend extended medication courses without clear ongoing benefit. 1
Never promise that any single intervention will definitely cure the problem - evidence shows similar modest effects across multiple treatments. 6, 4