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Sciatica - Treatment

Alternative Names

Neuropathy - sciatic nerve; Sciatic nerve dysfunction

Treatment:

Because sciatica is a symptom of another medical condition, the underlying cause should be identified and treated.

In some cases, no treatment is required and recovery occurs on its own.

Conservative treatment is best in many cases. Your doctor may recommend the following steps to calm your symptoms and reduce inflammation.

  • Apply heat or ice to the painful area. Try ice for the first 48 - 72 hours, then use heat after that.
  • Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).

Bed rest is not recommended. Reduce your activity for the first couple of days. Then, slowly start your usual activities after that. Avoid heavy lifting or twisting of your back for the first 6 weeks after the pain begins. You should start exercising again after 2-3 weeks. This should include exercises to strengthen your abdomen and improve flexibility of your spine.

See: Taking care of your back pain at home

If at-home measures do not help, your doctor may recommend injections to reduce inflammation around the nerve. Other medicines may be prescribed to help reduce the stabbing pains associated with sciatica.

Physical therapy exercises may also be recommended. Additional treatments depend on the condition that is causing the sciatica.

Nerve pain is very difficult to treat. If you have ongoing problems with pain, you may want to see a neurologist or a pain specialist to ensure that you have access to the widest range of treatment options.

Expectations (prognosis):

Often, sciatica will get better on its own. However, is it common for it to return.

Complications:

More serious complications depend on the cause of sciatica. See:

Calling your health care provider:

Call your doctor right away if you have:

  • Unexplained fever with back pain
  • Back pain after a severe blow or fall
  • Redness or swelling on the back or spine
  • Pain traveling down your legs below the knee
  • Weakness or numbness in your buttocks, thigh, leg, or pelvis
  • Burning with urination or blood in your urine
  • Pain that is worse when you lie down, or awakens you at night
  • Severe pain and you cannot get comfortable
  • Loss of control of urine or stool (incontinence)

Also call if:

  • You have been losing weight unintentionally
  • You use steroids or intravenous drugs
  • You have had back pain before but this episode is different and feels worse
  • This episode of back pain has lasted longer than 4 weeks
  • Reviewed last on: 6/4/2011
  • Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

References

Chou R, Qaseem A, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-491.

Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009;34(10):1078-93.

Jegede KA, Ndu A, Grauer JN. Contemporary management of symptomatic lumbar disc herniations. Orthop Clin North Am. 2010 Apr;41(2):217-24.

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