Treatment

Sciatica (disorder), Sciatica neuralgia, Neuralgia-neuritis of sciatic nerve, Sciatic neuralgia,

Treatment for sciatica isn't always necessary, as the condition often improves naturally within around six weeks.

If your symptoms are severe or persistent, your GP may recommend self-help measures and treatments such as medication and physiotherapy.

However, it's not clear exactly how effective many of these treatments areat treating sciatica.

In a small number of cases, surgery may be recommended to correct the spinal problem thought to be causing your symptoms.

How you can ease the pain yourself

Sciatica usually gets better in 4 to 6 weeks but can sometimes last longer.

To help relieve your pain and speed up your recovery:

Do

  • carry on with your normal activities as much as possible
  • regular back stretches
  • start gentle exercise as soon as you can – anything that gets you moving can help
  • hold heat packs to the painful areas – you can buy these from pharmacies
  • ask your pharmacist about painkillers that can help

Don't

  • sit or lie down for long periods – even if moving hurts, it's not harmful and can help you get better faster
  • take paracetamol on its own – this doesn't help with back pain or sciatica
  • use hot water bottles to ease the pain – you could scald yourself if your skin is numb

See a GP if the pain:

  • hasn't improved after trying home treatments for a few weeks
  • is getting worse
  • is stopping you doing your normal activities

Go to A&E or call the emergency number if you:

  • have sciatica on both sides
  • have weakness or numbness in both legs that is severe or getting worse
  • have numbness around or under your genitals, or around your anus
  • find it hard to start peeing, can't pee or can't control when you pee – and this isn't normal for you
  • don't notice when you need to poo or can't control when you poo – and this isn't normal for you

These could be symptoms of a serious back problem that needs to be treated in hospital as soon as possible.

Self-help

There are a number of things you can do yourself to help reduce troublesome sciatica symptoms.

These include:

  • remaining as active as possible
  • using hot or cold compresses
  • taking simple painkillers, such as paracetamol or ibuprofen

Exercise

It's important for you to remain as physically active as possible if you have sciatica.

Simple exercises, such as walking and gentle stretching, can help reduce the severity of your symptoms and strengthen the muscles that support your back.

Aim to do the following exercises every day, along with other activities like swimming or yoga.

While bed rest may provide some temporary pain relief, prolonged bed rest is often considered unnecessary and unhelpful.

If you've had to take time off work because of sciatica, you should aim to return to work as soon as possible.

You can make your own cold compression pack by wrapping a pack of frozen peas in a towel. Hot compression packs are usually available from pharmacies.

You may find it effective to use one type of pack followed by the other.

Medication

If you have persistent or troublesome sciatic pain, there are a number of medications that may help.

These include:

  • opioid medication, such as codeine, or morphinein severe cases
  • tricyclic antidepressants (TCAs), such as amitriptyline these medications were originally designed to treat depression, but they have since been found to help relieve nerve pain
  • anticonvulsants, such asgabapentin these medications were originally designed to treat epilepsy but, like TCAs, they can also be useful for treating nerve pain
  • a benzodiazepine called diazepam if you have muscle spasms

These medications aren't suitable for everyone, particularly when used in the long term, so it's important to discuss all available options with your GP. Some of these medications can also cause significant side effects in some people.

If the painkilling medications your GP prescribes don't help, you may be referred to a specialist pain clinic for further treatment.

Spinal injections

If other methods of pain relief have not worked, your GP may refer you to a specialist for a spinal corticosteroid or local anaesthetic injection.

This delivers strong anti-inflammatoryand painkilling medication directly to the inflamed area around the nerves of your spine.

Spinal injectionsare very effective at releasing the pressure on your sciatic nerve and temporarily reducing your pain for a few months.

Physiotherapy

In some cases, your GP may recommend a suitable exercise plan for you, or they may refer you to a physiotherapist.

A physiotherapist can 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.

Some surgical options include:

  • discectomy where the part of the herniated disc pressing on your nerve is removed; this is the most common type of surgery required
  • fusion surgery it may be possible to fuse a vertebra that has slipped out of place by using a metal or plastic cage between the vertebra, supported with metal rods and screws
  • laminectomy a procedure often used to treat spinal stenosis, wherea section of vertebrae called the lamina is removed

Many people have a positive result from surgery but, as with all surgical procedures, spinal surgery carries some risks.

Potential complications range from the relatively minor, such as an infection at the operation site, to the more serious, such as permanent damage to the spinal nerves.

Before choosing spinal surgery, your surgeon will discuss the relative risks and benefits with you.

Read about lumbar decompression surgery for more information about what surgery involves.

How to stop sciatica coming back

To reduce the chances of getting sciatica again:

Do

  • stay active – take regular exercise
  • use a safe technique when lifting heavy objects
  • make sure you have a good posture when sitting and standing
  • sit correctly when using a computer
  • lose weight if you're overweight

Don't

  • smoke – smoking can increase your risk of getting sciatica
Content supplied by the NHS Website

Medically Reviewed by a doctor on 23 Sep 2018