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The vast majority of patients with sciatica notice a significant improvement in the severity of their symptoms within 6-8 weeks. For this reason, initial treatment should be conservative to avoid unnecessary exposure to treatments. Instead, patients should be adequately counseled to understand the nature of the condition and equipped with methods to relieve the associated pain.
If another condition, such as cauda equina syndrome, is suspected to be involved, referral to a neurosurgeon should be made immediately.
During the initial consultation with a patient with sciatica, reassurance about the limited nature of the condition without specific treatment measures should be given.
In the meantime, it is recommended that affected individuals continue with normal daily activities as well as possible. Resting may provide some symptomatic relief, but does not help to speed recovery.
Some people may find that using hot or cold packs useful in the treatment of pain. Ice packs are recommended initially to help reduce pain and inflammation but after two to three days a hot pack may provide more beneficial pain relief.
Stretching the area in pain can also help to ease the pain. In some cases, referral to a physical therapist may be helpful or the individual may benefit from simple yoga exercises. Staying active is important and, although it is not expected to improve recovery time, it helps to improve natural pain relief mechanisms such as the release of endorphins.
The scientific evidence to support the use of analgesics to relieve the pain of sciatica is not strong. Despite this, analgesic medications are usually prescribed to help individuals manage the pain.
Paracetamol is usually the first choice of pain relief medication, as it is associated with fewer side effects. Alternatively, non-steroidal anti-inflammatory medications, such as ibuprofen and aspirin may be recommended.
In some cases, opioid drugs like codeine or morphine may be given, either alone or in combination with simple analgesics. Additional, botulinum toxin is sometimes used to relieve pain of sciatica caused by piriformis syndrome. Antidepressant medication is also occasionally prescribed, as it is thought to help with neuropathic pain.
Epidural injection of corticosteroid injection may help to provide pain relief for severe cases. However, this is only indicated for patients with severe symptoms, as the possible adverse effects are significant.
When the symptoms of sciatica persist to cause chronic pain, surgery may be considered as a treatment option.
The most common surgery is a discectomy, which involves the removal or part of the disc that is thought to cause the symptoms. However, the long-term benefits of this procedure do not seem to be superior to patients treated with conservative care.
There is some evidence that spinal manipulation may provide a benefit in the treatment of acute sciatica, although this has not been replicated for patients with chronic sciatica.
Some patients opt for acupuncture as a method of pain relief, although the benefit of this remains unclear. Likewise, chiropractic care can be used to manipulate the spine and improve mobility, although evidence for this practice is lacking.
Physical therapy is thought to have some beneficial effects and massage therapy may help to improve acute pain but is not associated with a shorter recovery period.