Sciatica Treatments and Medications

Sciatica, also known as lumbar radiculopathy, is a type of pain that starts from the lower back and travels through the buttocks and down the leg. It’s named after the sciatic nerve and often causes symptoms such as tingling, numbness, and weakness. Sciatica is usually caused by a pinched or irritated nerve along the lower spine. Most cases of sciatica get better on their own with self-care strategies. For many people, staying active, doing physical therapy exercises, and taking over-the-counter NSAIDs helps with pain and recovery. In severe cases, surgery may be recommended.

How is sciatica diagnosed?

A healthcare provider can diagnose sciatica by reviewing a person’s symptoms and medical history. In most cases, imaging tests are not needed. An assessment may include the following:

• Questions about your symptoms, when they occur, and what makes them worse

• Questions about your medical history, including risk factors like older age, a herniated disc, spinal stenosis, degenerative disc disease, pregnancy, and smoking

• A physical exam that includes specific mobility tests, such as a straight-leg raise while lying down

• CT scans for severe cases, especially if another underlying cause is suspected

Healthcare providers may also check for warning signs, such as severe weakness or loss of bladder and bowel control, that require immediate medical care. Determining the cause of the condition can help providers recommend the best treatment. 

Sciatic pain treatment options

Sciatica is a treatable condition that usually improves on its own. Most cases improve over time without surgery or intensive treatment. The main treatment is staying active as much as possible without extended periods of bed rest, physical therapy, and over-the-counter NSAIDs as needed. For more persistent or severe cases, prescription medications are available to help with the pain and inflammation. Surgery is only considered for severe cases caused by problems like a herniated disc or spinal stenosis. 

Medications for sciatica

Medications are not meant to cure sciatica, but they can help with pain and inflammation. Still, the evidence behind many medications for sciatica is limited. 

NSAIDs and acetaminophen

NSAIDs, or nonsteroidal anti-inflammatory drugs, are commonly recommended to help manage pain. Over-the-counter NSAIDs like ibuprofen and naproxen are often the first-line drug for sciatica pain. However, they should only be used for the short term, since long-term use and high doses may increase the risk of stomach and heart problems. Acetaminophen is a potential option for those who can’t take NSAIDs, but studies suggest it isn’t as effective for low back pain. 

Muscle relaxants

Prescription muscle relaxers can be helpful for pain exacerbated by muscle spasms. These options include methocarbamol and carisoprodol. Like NSAIDs, they’re meant for short-term use. Although they won’t fix the source of sciatica pain, they may help you stay active and do physical therapy. 

Nerve-pain medicines

Since sciatica involves nerve pain, healthcare providers may recommend a nerve pain medication such as gabapentin or pregabalin. Certain antidepressants like nortriptyline and duloxetine may also be used off-label for nerve pain. However, evidence for these medications is limited, so they’re only considered in a select few cases. 

Epidural steroid injection

Oral steroids like prednisone may help with improving mobility, but the current evidence is limited on whether they provide any meaningful benefit for sciatica pain. People with severe nerve pain may, however, experience short-term relief with an epidural steroid injection. 

Over-the-counter sciatica medicine

Most people with sciatica experience pain relief with an over-the-counter NSAID. In addition, heating pads, cold packs, and lumbar cushions may help relieve discomfort and are easily found at many pharmacies.

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