What is sciatica?
The sciatic nerve is the largest nerve in the body. It’s rooted in the lower back and extends through the rump, providing nerve endings through the leg. Sciatica or sciatic nerve pain is centered on the lower back, and the cause is usually from a ruptured disc in the spinal column that irritates or inflames the nerve. Bone, tumors, muscles, and infections can also cause inflammation of the sciatic nerve and the resulting back and leg pain.
What is the treatment for sciatica?
Bed rest has been traditionally advocated for the treatment of acute sciatica. But how useful is it?
To study the effectiveness of bed rest in patients with sciatica, a research team in the Netherlands led by Dr. Patrick Vroomen randomly assigned 183 such patients to bed rest or, alternatively, to watchful waiting for this period.
The results, reported in the New England Journal of Medicine, showed that after two weeks, 70% patients in the bed-rest group reported improvement, as compared with 65% of the patients in the control (watchful-waiting) group. After 12 weeks, 87% of the patients in both groups reported improvement. The results of assessments of the intensity of pain, the aggravation of symptoms, and functional status revealed no significant differences between the two groups. The extent of absenteeism from work and rates of surgical intervention were similar in the two groups.
The researchers concluded that “among patients with symptoms and signs of sciatica, bed rest is not a more effective therapy than watchful waiting.” Sometimes, conventional wisdom is not as wise as research!
Other treatment options for sciatica depend on its cause and include addressing the underlying cause. Transcutaneous nerve stimulators (TENS units) are sometimes useful for more chronic forms of sciatica. A variety of low back conditioning and stretching exercises are employed to help people recover from sciatica. Medications used in the treatment of sciatica include pain relievers, muscle relaxants, anti-inflammatories, and antidepressants. Antidepressants actually can help in this setting by reducing pain perception in the brain. Other medications that may be helpful include gabapentin (Neurontin) and duloxetine (Cymbalta).
Cortisone medications, given orally or by local injection (epidural injection), can sometimes be helpful in relieving sciatica.
Surgical procedures can sometimes be required for persisting sciatica that is caused by nerve compression at the lower spine. Sometimes pain management specialists help with chronic sciatica conditions.
What type of doctor treats sciatica?
Physician specialties that evaluate and treat sciatica range from generalists to subspecialists. These specialties include general medicine, family medicine, internal medicine, gynecology, orthopaedics, neurosurgery, rheumatology, pain management, and physiatry. Other health care providers for low back pain include physical therapists, chiropractors, massage therapists, psychologists, and acupuncturists.
Medically Reviewed on 2/11/2019
Firestein, Gary S., et al. Kelley’s Textbook of Rheumatology, Ninth Edition. China: Elsevier Health, 2012.