From the Guidelines
For patients with sciatica pain, clinicians should consider the addition of nonpharmacologic therapy with proven benefits, such as spinal manipulation, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, yoga, cognitive-behavioral therapy, or progressive relaxation, as these have shown small to moderate short-term benefits 1. When it comes to treatment for sciatica pain, the focus should be on reducing inflammation, relieving pressure on the sciatic nerve, and improving quality of life.
- Nonpharmacologic therapies are recommended as the first line of treatment, with spinal manipulation being associated with small to moderate short-term benefits for acute low back pain 1.
- For chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, yoga, cognitive-behavioral therapy, or progressive relaxation may be beneficial 1.
- Medications such as benzodiazepines and gabapentin may be considered for short-term pain relief, but their use should be limited due to risks of abuse, addiction, and tolerance 1.
- 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.
- Herbal therapies, such as devil's claw, willow bark, and capsicum, may be safe options for acute exacerbations of chronic low back pain, but their benefits are small to moderate 1. It is essential to note that the evidence is limited on the benefits and risks associated with long-term use of medications for low back pain, and therefore, extended courses of medications should generally be reserved for patients clearly showing continued benefits from therapy without major adverse events 1.
From the FDA Drug Label
Naproxen has been studied in patients with mild to moderate pain secondary to postoperative, orthopedic, postpartumepisiotomy and uterine contraction pain and dysmenorrhea. Onset of pain relief can begin within 1 hour in patients taking naproxen and within 30 minutes in patients taking naproxen sodium Analgesic effect was shown by such measures as reduction of pain intensity scores, increase in pain relief scores, decrease in numbers of patients requiring additional analgesic medication, and delay in time to remedication.
Naproxen may be used for the treatment of mild to moderate pain, but the label does not specifically mention sciatica pain.
- The analgesic effect of naproxen has been demonstrated in various types of pain.
- However, there is no direct information on the use of naproxen for sciatica pain in the provided drug label 2.
From the Research
Treatment Options for Sciatica Pain
- Conservative treatment is often the first approach for managing sciatica pain, but its effectiveness can vary 3
- Epidural steroid injections have shown promise in reducing leg pain and disability in patients with sciatica, particularly in the short-term 4, 5
- Surgical intervention may be more effective than non-surgical treatment for chronic sciatica-related back pain, but conservative treatment can significantly reduce leg pain and improve mental and physical health outcomes 6
Epidural Interventions
- Epidural corticosteroid injections have been found to be effective in reducing short-term leg pain, disability, and overall pain in patients with sciatica 4
- The American Society of Interventional Pain Physicians (ASIPP) recommends epidural interventions, including caudal, interlaminar, and transforaminal epidural injections, for the management of chronic spinal pain, including sciatica 7
- Percutaneous adhesiolysis has also been found to be effective in managing disc herniation and spinal stenosis, particularly in patients who are non-responsive to conservative management and fluoroscopically guided epidural injections 7
Effectiveness of Epidural Steroid Injections
- Epidural steroid injections have been shown to provide short- and medium-term pain relief for sciatica caused by lumbar disc herniation 5
- However, the long-term pain-relief effect of epidural steroid injections is limited, and they may not lead to significant improvement in sciatic nerve function 5
- Epidural steroid injections can also result in a reduction in opioid usage among patients with lumbar disc herniation 5