From the Guidelines
Treatment of Sciatica Treatment of an episode of sciatica typically involves a multimodal approach, including pharmacological and non-pharmacological interventions.
- Initial management may include over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400-800mg every 8 hours or acetaminophen 650-1000mg every 4-6 hours for pain relief, as well as muscle relaxants like cyclobenzaprine 5-10mg every 8 hours for muscle spasm 1.
- However, systemic corticosteroids are not recommended for treatment of low back pain with or without sciatica, because they have not been shown to be more effective than placebo 1.
- Non-pharmacologic therapies with proven benefits include spinal manipulation for acute low back pain, and intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, yoga, cognitive-behavioral therapy, or progressive relaxation for chronic or subacute low back pain 1.
- Physical therapy and lifestyle modifications, including regular exercise and proper posture, are also recommended to alleviate symptoms and prevent recurrence 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 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
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for sciatica, but their efficacy in pain reduction is not significant, as shown in a study published in 2016 2.
- However, NSAIDs may be more effective than placebo in terms of global improvement, with a risk ratio of 1.14 (95% CI 1.03 to 1.27) 2.
- Physical therapy referral from primary care for acute back pain with sciatica has been shown to improve disability and other outcomes compared to usual care, as demonstrated in a randomized controlled trial published in 2021 3.
- Nonpharmacological pain therapy, such as physical therapy, massage, manual therapy, electrotherapy, acupuncture, and music therapy, may be effective for chronic pain, but the evidence is not very high and often inconsistent 4.
- Lifestyle changes, including reduced smoking and alcohol consumption and increased physical activity, may also contribute to better outcomes in nonpharmacological treatment of chronic low back pain 5.
Multimodal Approach
- A multimodal approach to pain management, combining different treatments and therapies, may be more effective than single-agent treatments, as recommended by guidelines for the management of acute moderate-to-severe post-surgical, trauma-related, or musculoskeletal pain in adults 6.
- Multimodal analgesics, which combine agents targeting different pain pathways, may offer advantages over traditional single-agent treatments, including improved benefit-risk profiles and enhanced physicochemical and pharmacokinetic properties 6.
- Patient education initiatives and non-pharmacological measures, such as physical therapy and lifestyle changes, may also be important components of a multimodal approach to pain management 6.