Treating acute sciatica
Most cases of acute sciatica can be treated at home, as outlined below.
Over-the-counter (OTC) painkillers are usually effective in relieving pain. Painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are thought to work best. Ibuprofen is usually recommended rather than aspirin because there is less chance of adverse side effects. Children who are under the age of 16 should not take aspirin.
NSAIDs may not be suitable if you have asthma, high blood pressure, liver disease, heart disease or a history of stomach and digestive disorders. In these circumstances, paracetamol is likely to be a more suitable painkiller for you. Your GP or pharmacist will be able to advise you.
If OTC painkillers are not effective in relieving your pain, your GP may prescribe a mild opiate-based painkiller, such as codeine, or if your symptoms are very severe, a muscle relaxant such as diazepam.
Diazepam can make you feel sleepy, so you should not drive if you have been prescribed this medication. After your course of medication has ended, you should wait at least 24 hours before driving.
Diazepam will also make the effects of alcohol worse so avoid excessive drinking while you are taking the medication. Diazepam has the potential to be habit-forming, so your GP will not usually prescribe more than a seven-day course of the medication.
If you have sciatica, it is important for you to remain as physically active as possible. While bed rest may provide some temporary pain relief, prolonged bed rest may be unnecessary. Recommended exercises include walking and gentle stretching exercises.
If you have had to take time off work due to sciatica, you should aim to return to work as soon as possible.
Many people find that using either hot or cold compression packs helps to reduce pain. You can make your own cold compression pack by wrapping a package of frozen food in a towel. Hot compression packs are usually available from larger pharmacies. You may find it effective to use one type of pack after another.
Treating chronic sciatica
Chronic sciatica usually requires a combination of self-help techniques and medical treatment. Treatment options are outlined below.
The long-term use of NSAIDs as a method of controlling pain is not usually recommended because they can cause problems with your stomach and digestive system, such as ulcers or internal bleeding.
If you need pain relief over a long time, the painkillers listed below may be used:
- codeine (paracetamol is often prescribed in combination with codeine)
- a tricyclic antidepressant, such as amitriptyline
gabapentin (where nerves are thought to be inflamed) or, in capsules, a similar drug called pregabalin
Amitriptyline was originally designed to treat depression but doctors have now found it is also useful for treating nerve pain. You may experience some side effects when taking amitriptyline, including:
- dry mouth
- blurred vision
- difficulty urinating
Do not drive if you find that amitriptyline makes you drowsy. Amitriptyline should not be taken by people with a history of heart disease.
Gabapentin was originally designed to prevent seizures in people with epilepsy. However, like amitriptyline, it has been found to be useful for treating nerve pain.
Possible side effects of gabapentin include:
- loss of coordination
Do not drive if you find that gabapentin is making you drowsy.
Do not suddenly stop taking gabapentin as you may experience withdrawal symptoms such as anxiety, insomnia, nausea, pain and sweating. If you want to stop taking gabapentin or no longer need to take it, your GP will arrange for your dose to be slowly reduced over the course of a week so you do not experience withdrawal symptoms.
Injection of a corticosteroid
If other methods of pain relief have not worked, your GP may refer you to a specialist for an epidural steroid injection. This delivers strong anti-inflammatory medication directly to the inflamed area around the nerves of your spine. This should release the pressure on your sciatic nerve and reduce your pain.
Exercise and physiotherapy
As with acute sciatica, if you have chronic sciatica you should try to remain as physically active as possible because this will reduce the severity of your symptoms. It is also recommended that you continue to work or return to work as soon as possible.
Regular exercise will help to strengthen the muscles that support your back. Exercise also stimulates the production of endorphins, which are natural painkilling chemicals.
Your GP may recommend a suitable exercise plan for you or refer you to a physiotherapist. A physiotherapist can teach you a range of exercises that strengthen the muscles that support your back and improve the flexibility of your spine. They can also teach you how to improve your posture and reduce any future strain on your back.
Cognitive behavioural therapy (CBT)
Some studies have shown that CBT can help in the management of chronic pain that is caused by sciatica.
CBT is based on the principle that the way we feel is partly dependent on the way we think about things. Research has shown that people who train themselves to react differently to their pain, by using relaxation techniques and maintaining a positive attitude, show a decrease in the levels of pain that they experience.
They are also more likely to remain active and take exercise, further reducing the severity of their symptoms.
For more information, see Health A-Z topic on cognitive behavioural therapy.
Surgery may be an option to treat cases of chronic sciatica when:
- there is an identifiable cause, such as a slipped or herniated disc
- the symptoms have not responded to other forms of treatment
- the symptoms are getting progressively worse
The type of surgery that will be recommended for you will depend on the cause of your sciatica. Some surgical options include:
- discectomy: where the part of the herniated disc pressing on your nerve is removed (this is the most common type of surgery required)
- fusion surgery: if a vertebra has slipped out of place, it may be possible to fuse it into place using a bone graft supported by metal rods
- laminectomy: a procedure often used to treat spinal stenosis, this removes or trims the arch of a vertebra (bone) to relieve the pressure on the nerves
Many people have a positive result from surgery, but as with all surgical procedures, spinal surgery carries some risks. There is a risk of infection and of the surgery failing, and a low risk that your spinal nerves will be damaged during surgery. This could result in muscle weakness.
Before opting for spinal surgery, your surgeon will discuss the relative risks and benefits with you.
See the Health A-Z topic on Lumbar decompressive surgery for more information on spinal surgery.