Sciatica - Treating sciatica

Treatment for sciatica is not always necessary, as the condition often improves naturally within around six weeks.

However, if your symptoms are severe or persistent, a number of treatments are available.

These usually include self-help and conservative treatments, such as medication and physiotherapy, although it's not clear exactly how effective many of these treatments are in treating sciatica.

In a small number of cases, surgery may be recommended to correct the problem in your spine that is 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 remaining as active as possible, using hot or cold compresses, and taking simple painkillers, such as paracetamol or ibuprofen.

Exercise

If you have sciatica, it's important for you to remain as physically active as possible.

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 have had to take time off work due to 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.

Painkillers

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

• paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
• opioid medication, such as codeine or, in severe cases, morphine
• 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 as gabapentin – these medications were originally designed to treat epilepsy but, like TCAs, they can also be useful for treating nerve pain

These medications are not 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 and/or local anaesthetic injection.

This delivers strong anti-inflammatory and painkilling medication directly to the inflamed area around the nerves of your spine, which may help release the pressure on your sciatic nerve and temporarily reduce your pain.

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.

Read more about physiotherapy.

Surgery

Surgery is rarely necessary to treat sciatica, although it may be considered if the condition has an identifiable cause, such as a herniated or "slipped" disc, the symptoms have not responded to other forms of treatment, or the symptoms are getting progressively worse.

The type of surgery recommended will depend on the cause of your sciatica. 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, 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.

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