Sciatica

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

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 are at treating sciatica.

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

Self-help

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

These include:

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.

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.

Read more about exercises for sciatica.

Compression packs

Some people find that using either hot or cold compression packs on painful areas can help to reduce the pain.

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.

Prescription medicines

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

These include:

  • some types of antidepressant, such as amitriptyline and duloxetine –these medications were originally designed to treat depression, but they have since been found to help relieve nerve pain
  • anticonvulsants, such as gabapentin and pregabalin – these medications were originally designed to treat epilepsy, but they can also be useful for treating nerve pain
  • a medicine 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 and your pain is severe, your GP may refer you to a specialist for a spinal corticosteroid or local anaesthetic injection.

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

Spinal injections are 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.

Your GP may also suggest taking part in a group exercise class led by a physiotherapist.

Read more about physiotherapy.

Manual therapy

Manual therapy is the name for a group of treatments where a therapist uses their hands to move, massage and apply careful force to the muscles, bones and joints in and around your spine.

It's usually carried out by chiropractors, osteopaths or physiotherapists, although chiropractic and osteopathy aren't widely available on the NHS.

Manual therapy can help reduce sciatica pain, but it shouldn't be used on its own. It should only be used alongside other measures such as exercise.

Psychological support

Your GP may suggest psychological therapy as part of your treatment plan, in addition to other treatments such as exercise and manual therapy.

Therapies such as cognitive behavioural therapy (CBT) can help you manage your pain better by changing how you think about your condition.

While the pain in your back is very real, how you think and feel about your condition can make it worse.

If you've been in pain for a long time, a specialist treatment programme that involves a combination of group therapy, exercises, relaxation and education about pain and the psychology of pain may be offered.

Surgery

Surgery is rarely needed for sciatica.

But a type of surgery called lumbar decompression surgery may be considered if:

  • the condition has an identifiable cause, such as a slipped disc
  • the symptoms haven't responded to other forms of treatment
  • the symptoms are getting progressively worse

Decompression surgery can involve several different techniques, such as:

  • 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, where a 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.

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