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

Some women experience sciatica symptoms during pregnancy due to the growing uterus pressing against the sciatic nerve. Certain occupations can increase the risk of developing sciatica. For example, sitting for long periods can place pressure on the spinal cord nerves, such as truck drivers and machine operators (who experience prolonged whole-body vibration).

Many people seek medical advice for sciatica pain relief if at-home remedies, such as applying heat and over-the-counter pain relievers, do not help alleviate symptoms. Your family physician might treat your sciatica or could refer you to a specialist, such as a neurologist, physical therapist, or pain management physician.

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.

Sometimes doctors diagnose sciatica based on a physical evaluation and your description of symptoms. If the pain does not go away or if it is severe, your doctor may order tests such as X-ray, MRI, CT scan, electromyography. These tests are used to determine underlying causes, such as bone spurs, disc herniation, nerve compression, or lumbar stenosis.

Sciatica shares symptoms with piriformis syndrome. Spasms of the piriformis muscle, located in the buttocks, irritate the sciatic nerve, causing numbness and tingling as well as pain down the back of the leg. Treatment for this condition includes a combination of physical therapy, heat/cold therapy, corticosteroid injections, or Botox injections.

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).

Chronic sciatica is a life-long condition, and doctors might suggest more aggressive treatment. Although the pain with chronic sciatica is usually milder, it might require treatment during flare-ups. There are several treatment options, including home care, medications, corticosteroid injections, physical therapy, and surgery. Several conditions that can cause sciatica improve with surgery, such as herniated disc, spinal stenosis, spondylolisthesis, and a tumor on the spine. However, surgery is generally a last resort, according to John Hopkins Medicine.

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, and 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.

• Anticonvulsants: 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, increased 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 the 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.

Choosing the best medication

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.

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