Sciatica Treatments and Medications

What is sciatica?

Sciatica, medically known as lumbar radiculopathy, is caused by pressure on or irritation of the sciatic nerve roots located in the lower lumbar spine. This pressure causes severe pain, numbness, and weakness that starts in the lower back and radiates down, causing leg pain. It can also cause chronic low back pain. It is a common condition, with between 10 and 40 percent of the population in the United States, experiencing symptoms of sciatica at some point in their lives, according to a report published in 2019. Both men and women are equally likely to develop sciatica. Treatment includes a combination of physical therapy, at-home remedies, and medication when needed.

Sciatica diagnosis

Although you can develop sciatica at any age, it most often shows up during the 40s. It occurs in both men and women. One possible cause is a genetic predisposition, according to a few studies, although other studies have not found this to be significant. Commonly known risk factors for the development of sciatica include personal factors (e.g., smoking, stress, height, and age group). Some common causes of sciatica, according to a report published in the British Medical Journal include:

• Lumbar spinal stenosis
• Degenerative disc disease
• Spondylolisthesis
• Muscle spasms in lower back or buttocks
• Spinal cord injury

Preparing for your doctor's appointment

Your doctor will start by asking you questions about your sciatic symptoms, such as whether it starts or worsens after specific activities. They also do a physical examination, which can include checking muscle strength and reflexes. Your doctor might ask you to perform certain physical activities, such as lifting one leg at a time, getting up from squatting position, standing from lying down, walking on heels or toes. Pain from sciatica often worsens during these activities.

Some questions to ask your doctor after being diagnosed with sciatica:

• Are there things I can do at home to relieve pain?
• Are there activities I should avoid because they may worsen pain?
• What medications are available?
• Are non-medication treatments available?
• How long will I need to take medication?
• Can my sciatica be cured, or will I continue to have flares?
• What is causing sciatica?

Sciatic pain treatment options

Treatment of sciatic nerve pain usually includes a combination of over-the-counter medications and home care. For about 80 to 90 percent of those with acute sciatica, symptoms resolve themselves within several weeks, according to the American Academy of Orthopaedic Surgeons (AAOS).

Medical therapies to help manage sciatica pain include:

• Oral non-steroidal anti-inflammatory drugs (NSAIDs)
• Prescription pain medication
• Muscle relaxants
• Anticonvulsant
• Oral corticosteroids
• Corticosteroid injections
• Physical therapy
• Surgery

Medications for sciatica

There are five types of drugs used to treat sciatica. They include:

• Acetaminophen and NSAIDs: Over-the-counter pain relievers and non- steroidal anti-inflammatory medications, such as aspirin, ibuprofen, and naproxen are often helpful for relieving acute pain. These are for short-term use. Speak with your doctor if you require pain relief for more extended periods. Side effects include stomach upset and irritation of the digestive lining
• Muscle relaxers: When the underlying cause of sciatica is muscle spasms, muscle relaxers can help. These include carisoprodol (Soma), cyclobenzaprine (Fexmid®), and methocarbamol (Robaxin, Robaxin-750). Muscle relaxers can cause confusion in older patients. Side effects include fatigue, dizziness, drowsiness, dry mouth, decreased blood pressure.
• Tricyclic antidepressants: Antidepressants can help reduce nerve pain. When used to help manage pain, doctors prescribe them at lower doses than for depression. These include amitriptyline (Elavil) and nortriptyline (Pamelor). Side effects include dry mouth, constipation, weight gain or loss, low blood pressure, rash, and increased heart rate
• Anticonvulsant: These types of medications blunt pain signals in the nerves, which reduces the pain from sciatica. It can take up to three to four weeks to feel the full effects, and you must continue to take them, even when you are not experiencing pain. These include gabapentin (Gralise, Neurontin, Horizant) and pregabalin (Lyrica). Side effects include dizziness, drowsiness, fatigue, nausea, tremor, rash, and weight gain.
• Steroids: The medication prednisone is an oral medication used to reduce inflammation. Side effects include high blood pressure, insomnia, increased appetite, increase the growth of body hair, and blurred vision. Steroids can also be injected directly into the lower back to reduce swelling and inflammation. The injection gives a stronger dose directly into tendons in the problem area. The relief from steroid injections can last for several months. Side effects include cartilage damage, joint infection, weakening of tendons, and thinning of bone, skin, and soft tissue around the injection site.

Best medications for sciatica

There are many different choices of treatments for sciatica, and there is no "best" medication. What works for one person might not work for another. Everyone reacts differently to medicines, and it sometimes takes time to find the right drug and the correct dosage for you. Your doctor will take your medical condition, medical history, and other medication you are taking into consideration when suggesting a treatment for you.

Side effects of sciatica medications

The following is a list of some common side effects for sciatica medications. It is not a comprehensive list. Before taking any medication, you should consult with a medical professional about all the possible side effects and interactions with other medicines.

Acetaminophen and NSAIDs

• Stomach upset
• A tendency to bleed more
• Headaches
• Dizziness
• Ringing in the ears
• Liver or kidney problems

Muscle relaxers

• Fatigue
• Weakness
• Drowsiness
• Dry mouth
• Depression
• Decreased blood pressure

Tricyclic antidepressants

• Blurred vision
• Dry mouth
• Constipation
• Weight gain
• Low blood pressure
• Increased heart rate
• Rash

Anti-convulsant

• Dizziness
• Drowsiness
• Fatigue
• Nausea
• Tremor
• Weight gain
• Rash

Steroids – Oral and Injection

• Insomnia
• Mood changes
• Weight gain
• Acne
• Thinning skin and bruising
• Headache
• Dizziness
• Heart disease
• Adrenal insufficiency
• Osteoporosis

Treating sciatica at home

At-home care for acute sciatica or a flare-up of chronic sciatica includes:

• Hot/cold backs to reduce acute pain
• Avoiding prolonged sitting or standing
• Light exercising such as walking or swimming
• Gentle stretching of lumbar spine and hamstrings
• Over-the-counter NSAIDs
• Moderate bed rest

There are also some lifestyle changes you can make to help prevent pain and flare-ups:

• Incorporate low-impact aerobic exercise into your daily routine
• Maintain good posture
• Lift things correctly
• Lose weight, if overweight
• Stay active within your limits of pain, avoid activities that worsen pain
• Avoid sitting or standing for long periods
• Avoid high heel shoes
• Sleep on a firm mattress

Home remedies for sciatica

There is some research to indicate that natural treatments can be effective in managing pain from sciatica.

Can sciatica nerve pain go away on its own?

Most of the time, sciatica goes away on its own, according to UT Southwestern Medical Center. For many people, acute sciatica will resolve itself within several weeks. Using over-the-counter NSAIDs and staying as active as possible can help you get through the flare of sciatica.

How long does it take for sciatica to go away?

Sciatica can be either acute or chronic. An acute episode usually resolves itself within a few weeks. Some people experience several severe bouts of sciatica each year. Chronic sciatica is life long, and you can experience pain regularly, although the pain usually is milder than in an acute episode. Chronic sciatica doesn't respond well to treatment. Lifestyle changes, such as exercising daily, practicing yoga, and losing weight can help to reduce discomfort from chronic sciatica. Surgery is a last resort option if no other treatments provide enough relief, and the pain and discomfort interfere with your daily activities.

What is the best pain killer for sciatica?

Each person reacts differently to medications, so there isn't one "best pain killer." For acute episodes, many people find over-the-counter NSAIDs relieve the pain. For chronic sciatica, some find tricyclic antidepressants or anticonvulsants are the best options. It may take some time to find the best treatment for you.

Do anti-inflammatories help sciatica?

Anti-inflammatories, such as NSAIDs, help many people with sciatica. You should only take these on a limited basis. When taking for extended amounts of time, it is crucial to speak with your doctor. Some anti-inflammatories, such as steroids, are only available through your doctor, either orally or as an injection. Because inflammation puts pressure on your sciatic nerve, relieving the inflammation often helps ease the pain.

Is heat or cold better for sciatica pain?

For acute episodes, cold packs or ice can reduce inflammation, alleviating some of the pain. Cold packs are best applied for the first two to seven days of an acute episode, according to Spine-Health.com. Once the acute pain has subsided, heat packs can be used to increase the flow of oxygen to the area.

Resources

• Sciatica
• Diagnosis and treatment of sciatica
• 5 Questions to Answer Before Considering Sciatica Surgery
• Deep Tissue Massage and Nonsteroidal Anti-Inflammatory Drugs for Low Back Pain: A Prospective Randomized Trial
• Yoga as a treatment for chronic low back pain: A systematic review of the literature