From the Guidelines
Sciatica treatment should begin with conservative approaches, including over-the-counter pain relievers, ice or heat therapy, and gentle stretching exercises, before considering more invasive options. The goal of treatment is to reduce inflammation, relieve pain, and improve quality of life.
Initial Treatment
- Start with over-the-counter pain relievers like ibuprofen (400-800mg every 6-8 hours) or naproxen (220-500mg twice daily) to reduce inflammation and pain 1.
- Apply ice packs for 20 minutes several times daily during the first 48-72 hours, then switch to heat therapy.
- Gentle stretching exercises targeting the piriformis muscle, hamstrings, and lower back can help relieve pressure on the sciatic nerve.
Nonpharmacologic Therapy
- For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits, such as spinal manipulation for acute low back pain, or intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation for chronic or subacute low back pain 1.
- Physical therapy focusing on core strengthening and proper body mechanics is often beneficial for long-term management.
Pharmacologic Therapy
- For moderate to severe pain, your doctor may prescribe muscle relaxants like cyclobenzaprine (5-10mg three times daily) or stronger pain medications temporarily 1.
- However, 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.
Lifestyle Modifications
- Maintain proper posture, avoid prolonged sitting, and use ergonomic chairs with lumbar support.
- If symptoms persist beyond 6-8 weeks, corticosteroid injections near the affected nerve may provide relief.
- Surgery is typically reserved for cases with significant nerve compression or when conservative treatments fail after several months.
From the Research
Sciatica Treatment Options
- Conservative treatment is often the first approach for managing sciatica, with the natural course of the condition appearing to be favorable 2
- However, the additional value of many conservative therapies remains controversial, with some studies suggesting that epidural steroids may be beneficial for subgroups of nerve root compression 2
- Surgery is also an option for sciatica treatment, with some studies comparing the effectiveness of early surgery versus prolonged conservative treatment 3, 4
Effectiveness of Different Treatments
- A systematic review of conservative treatments for sciatica found that neither traction, exercise therapy, nor drug therapy was unequivocally effective 2
- Another study found that combination drug therapy for low back pain and sciatica had no or small effect on pain and disability, with limited evidence to support its use 5
- A review of drugs for relief of pain in patients with sciatica found that the evidence for their efficacy and tolerability was of moderate to low quality, with most pooled estimates not favoring active treatment over placebo 6
Predictors of Treatment Outcome
- Age above 40 years, severe leg pain at baseline, and a higher affective McGill pain score were found to be predictors of unsatisfactory recovery in patients with sciatica 3
- The recovery pattern of patients with sciatica can be variable, with some patients experiencing ongoing complaints that fluctuate over time, irrespective of treatment 3