How is sciatica treated?
The good news for patients is that sciatica usually
will get better on its own, and the healing process
usually only takes a few days or weeks. Overall,
the vast majority of episodes of sciatica pain heal
on their own within a six to twelve week time span.
However, occasional flare-ups of sciatic nerve pain
may be an indication of a condition that should be
managed so that it does not get worse over time. For
most, readily available pain management techniques
and regular exercise will go a long way to remedying
the situation. For
others, when the pain is severe or does not get better
on its own, a more structured pain management program
(including specific physical therapy and exercise),
and possibly surgery, may offer the best approach to
finding pain relief and preventing or minimizing future
flare-ups of sciatica.
Conservative care for sciatica
During an episode of sciatica, there are a number
of conservative care (non-surgical) options available
to help alleviate the sciatic pain and discomfort.
Heat/ice for sciatica
For acute sciatica pain, heat and/or ice packs are most readily available and
can help alleviate the pain, especially in the acute phase. Usually ice or heat
is applied for approximately 20 minutes, and repeated every two hours. Most people
use ice first, but some people find more relief with heat. The two may be alternated
to help with sciatica pain relief.
Medications for sciatica
Over-the-counter or prescription medications may also be helpful in relieving
sciatica. Non-steroidal anti-inflammatory drugs (NSAIDs) or oral steroids
can be helpful in reducing the inflammation and pain associated with sciatica.
Epidural steroid injections for sciatica
If the sciatica pain is severe, an epidural steroid injection can be performed
to reduce the inflammation. An epidural injection is different from oral medications
because it injects steroids directly to the painful area around the sciatic nerve
to help decrease the inflammation that may be causing the pain. While the effects
tend to be temporary (providing pain relief for as little as one week up to a
year), an epidural steroid injection can be very effective in providing relief
from an acute episode of sciatic pain. Importantly, it can provide sufficient
relief to allow a patient to progress with a conditioning program.
Conservative care specialists for sciatica
A visit to a physical therapist, osteopathic physician, chiropractor or physiatrist
can be helpful both to alleviate the painful symptoms and to help prevent future
recurrences of sciatica. These conservative care professionals can assist in
providing pain relief and developing a program to condition the lower back.
Surgical treatments for sciatica
If the sciatica pain is severe and has not gotten
better within six to twelve weeks, it is reasonable
to consider spine surgery. Depending on the cause and
the duration of the sciatica pain, one of two surgical
procedures may be considered: a microdecompression
(microdiscectomy) or an open decompression (lumbar
laminectomy).
Microdiscectomy (microdecompression) for sciatica
In cases where the
sciatica pain is due to
a disc herniation, a microdiscectomy
may be considered after
4 to 6 weeks if the pain
is not relieved by conservative
means. Urgent surgery is
only necessary if there
is progressive weakness
in the legs, or sudden
loss of bowel or bladder
control. A microdiscectomy
is typically an elective
procedure, and the decision
to have surgery is based
on the amount of pain and
dysfunction the patient
is experiencing, and the
length of time that the
pain persists. Approximately
90% to 95% of patients
will experience relief
from their sciatica pain
after this type of surgery.
Lumbar laminectomy (open decompression) for
sciatica
Lumbar spinal stenosis often causes sciatica
pain that waxes and wanes over many years. Surgery
may be offered as an option if the patient’s
activity tolerance falls to an unacceptable level.
Again, surgery is elective and need only be considered
for those patients who have not gotten relief from
the sciatica after conservative treatments. After
a lumbar laminectomy (open decompression), approximately
70% to 80% of patients experience relief from their
sciatic nerve pain.
By: Stephen
H. Hochschuler, MD
March 30, 2000
Updated September 21, 2005
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