Acute or short term sciatica will respond to treatment at home with pain relief medication. Chronic or persistent sciatica, on the other hand will require both medical treatment and self-help techniques.
Acute sciatica, will usually respond to pain control in the form of paracetamol, and an NSAID - non steroidal anti-inflammatory drug such as Diclofenac or Ibuprofen, and continuing as much as possible with daily activities.
In the case of chronic or persistent sciatica, then pain control will also be necessary, but perhaps also with the use of steroids or stronger pain relief in the form of a mild opiate such as codeine, which can be prescribed as a combination tablet formulation with paracetamol. This will need to be prescribed by a physician, who will also make a referral for physiotherapy, and exercise regimes designed to strengthen the muscles of the back. In the case of more persistent or severe cases surgery to correct the disc bulge, may be necessary.
There is an ongoing debate in the medical profession as to the relative efficacy of the nonsurgical intervention strategies for patients with sciatica. This includes an updated Cochrane review which was published in 2005. This arose from within the Cochrane collaboration back review group. The objective of the study was to conduct a systematic review of the available evidence for the efficacy of advice to have bed rest compared with the advice to stay active for patients with sciatica and lower back pain. All the trials examined were of a high quality. The evidence from the review showed moderate quality evidence of little difference in pain (as measured by standardised mean differences, with a 95% confidence interval) between bed rest and staying active.
In another study examined a random controlled trial that was used to compared the efficacies of 3 nonsurgical treatment strategies in patients at a general practice, with sciatica. The hypothesis was that bed rest, physiotherapy and continuing with activities of daily living are of equivalent efficacy. The trial was designed for the comparison of each. The conclusion was that bed rest and physiotherapy are not more effective in acute sciatica than continuing normal daily activities.
Drug therapy centers around pain relief in the form of steroids, Paracetamol, NSAIDs such as Ibuprofen or Diclofenac. Mild opiates such as codeine can be used in the short term, where the pain is severe, or if a muscle relaxant is needed, Diazepam. This can be habit forming so a GP will prescribe this in the short term only, or as a one off treatment. A combination of Paracetamol and an NSAID like Diclofenac can be quite effective, although, again only in the short term. NICE - the National Institute for Health and Care Excellence issued a clinical knowledge summary in January 2013 in which they discuss the prescribing issues associated with NSAIDs, including adverse affects which arise from their long term use. Most commonly these come from gastrointestinal problems, including ulcers and bleeding. NSAIDs can also cause complications such as myocardial infarction and high blood pressure, but these are rare. However NSAIDs are contraindicated where high blood pressure is present.
In severe cases, and after other pain relief methods have been tried, steroids can be considered. This is administered by a specialist, and involves delivering a dose of steroids by epidural injection. The purpose of this is to direct a strong anti-inflammatory medication directly to the area around the nerves at the spinal root. This will result in the release of pressure on the nerve and so reduce the pain.
Exercise and maintaining regular daily activities with sciatica is important. Bed rest may provide some temporary pain relief, but prolonged bed rest may not be necessary. Regular exercise helps to strengthen the muscles involved in supporting the back. Also physiotherapy can help with this, and improves flexibility in the back. It can also recover movement and function to an affected area. The approach of physiotherapy is to use a combination of movement & exercise and manual therapy techniques. This is where the therapist aids recovery by using their hands to relive muscle pain and stiffness and encourage blood flow to the injured area.
Spine 2005; 30: 542-6.
Health Council of the Netherlands: management of the lumbar sacral radicular syndrome (sciatica): Health Council of the Netherlands, 1999; publication no. 1999/18.
Luijsterburg PAJ et al. Effectiveness of conservative treatments for the lumbar sacral radicular syndrome: a systematic review. Eur Spine J 2007 Apr 6;(Epub ahead of print).
Waddell G. The back pain revolution. Edinburgh: Churchill Livingstone, 1998.