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Treatment for Sciatica
Treatment of sciatica depends on the severity of the pain. A combination of therapies is typically used to minimize the pain, including analgesic and adjuvant pain medications, systemic corticosteroids, physiotherapy, and other supportive therapies. However, in some cases, surgical intervention may be required to control the symptoms.
Most cases of acute sciatica resolve with just conservative (non-surgical) treatments in a few weeks. However, the effectiveness of the conservative treatments remains controversial. Many researchers have urged that conservative treatments do not clearly reduce the sciatica symptoms.
For chronic sciatica, your doctor may prescribe a combination of self-help techniques and medications and may advise joining a structured exercise course under the supervision of an experienced physiotherapist. You may also try chiropractic or osteopathy as an alternative treatment for relieving pressure on the sciatic nerve. But if your condition gets more worse, your doctor may suggest surgical treatment.
Conservative Treatment for Sciatica
The conservative treatment of sciatica primarily focuses at pain reduction, either by painkillers or by relieving pressure on the nerve root. You can do a group of things to relieve the symptoms, such as using ice pack or heating pads, taking painkillers, exercise, and rest. However, complete bed rest is not recommended by physicians.
After examining your condition, your doctor may suggest one or some combination of the following treatments.
Drugs usually prescribed for the treatment of sciatica include non-steroidal anti-inflammatory drugs or NSAIDs (such as naproxen, ibuprofen, or COX-2 inhibitors), narcotic analgesics, muscle relaxants, benzodiazepines, tricyclic antidepressants, and anticonvulsants.
However, these drugs provide unclear, temporary benefits in reducing the symptoms and are often associated with a range of safety concerns. Moreover, there has been much debate over their effectiveness against the sciatic pain. A review published in the British Medical Journal reported that no clear evidence exists for painkillers and antidepressants being superior to placebo.
If your pain is more severe and NSAIDs or other pain medications aren't helping that much, your doctor may suggest an epidural steroid injection directly into the area around the affected nerve root.
Corticosteroids have been thought to help ease the pain by minimizing inflammation around the involved sciatic nerve. However, evidence behind the corticosteroid therapy for sciatica is lacking. Although a review published (2000) in the Journal of Spinal Disorder suggested that epidural steroids might be beneficial in suppressing the nerve root compression, but a recent systematic review of thirty trials reported that no evidence of a positive effect was found with corticosteroid injections.
Surgical intervention for sciatica is usually reserved for patients who have a herniated lumbar disc or for times when the compressed or irritated sciatica nerve causes substantial weakness, bowel or bladder incontinence or when you have a severe pain that is getting progressively worse. Surgery provides a better short-term relief of leg pain than conservative treatments, but long-term reliefs appear to be similar to conservative care.
Surgery for sciatica often involves removal of bone spur or part of the herniated disc. The primary goal of a surgical treatment is aimed at minimizing the leg pain and associated symptoms and not at reducing the back pain.