Treating acute sciatica
Most cases of acute sciatica can be treated at home. These are outlined below.
Painkillers
Over-the-counter (OTC) painkillers are usually effective in relieving symptoms of pain. The type of painkiller known as nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, is 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 would probably 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.
If your sciatica symptoms are very severe, your GP may prescribe a muscle relaxant, such as diazepam. Diazepam can make you feel very sleepy, so if you have been prescribed this medication you should not drive at all. 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 you should 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.
Exercise
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.
Compression packs
Many people find that using either hot, or cold, compression packs helps to reduce pain. You can make you 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 helpful to use one type of pack after another.
Treating chronic sciatica
Treating chronic sciatica will probably require a combination of self-help techniques and medical treatment. Treatment options are outlined below.
Painkillers
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.
Therefore, if you are required to take painkillers for a considerable length of time, the ones that are listed below may be used.
- paracetamol,
- codeine - paracetamol is often prescribed in combination with codeine,
- amitriptyline (a tricyclic antidepressant) , and
- gabapentin (where nerves are thought to be inflamed) or, in capsules, a similar drug called pregabalin .
Amitriptyline is a medicine that was originally designed to treat depression, but subsequently doctors have found that it is also useful for treating nerve pain. You may experience some side effects when taking amitriptyline. They include:
- drowsiness,
- dry mouth,
- blurred vision,
- constipation, and
- difficulty urinating.
Do not drive if you find that amitriptyline is making you drowsy. Amitriptyline should not be taken by people with a history of heart disease.
Gabapentin is a medicine that was originally designed to prevent seizures in people with epilepsy but, like amitriptyline, it has been found to be useful for treating nerve pain.
Possible side-effects of gabapentin include:
- drowsiness,
- dizziness,
- tiredness, and
- loss of coordination.
Do not drive if you find that gabapentin is making you drowsy. You should not suddenly stop taking gabapentin as you will experience withdrawal symptoms. These could include
- anxiety,
- insomnia,
- nausea,
- pain, and
- sweating.
If you wish to stop taking gabapentin, or you no longer need to take it, your GP will arrange for your dose to be slowly reduced over the course of a week. This method will ensure that you do not experience any 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 promotes the production of endorphins, which are natural pain killing chemicals. Your GP should be able to recommend a suitable exercise plan for you.
Your GP may also refer you to a physiotherapist, or a chiropractor. A physiotherapist will be able to 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 Behaviour Therapy (CBT)
Some studies have shown that a type of therapy called cognitive behavioural therapy (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 A-Z topic on cognitive behavioural therapy.
Surgery
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 that is 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 metal rods, and
- laminectomy - this procedure is 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 A-Z topic on Lumbar decompressive surgery for more information on spinal surgery.