Sciatica is a common and painful problem that occurs when the sciatic nerve becomes inflamed or irritated. This is the longest and largest nerve in the body, starting at the base of the spine and extending down through the buttock, thigh, knee and calf, right to the ankle. Sciatica treatment needs to be tailored to the severity of the pain and any other symptoms such as tingling and weakness, and the length of time the pain has lasted.
Some cases of sciatica do arise with no obvious explanation, even after careful examination and imaging tests. More often, the cause of sciatica is a slipped disc, a problem with the spine that is due to ageing, or an injury. Rare causes include infection or a spinal tumour.
Changes in the spine can crush or damage the sciatic nerve, causing pain that starts in the back and buttock and then extends down the leg and into the calf. The pain can be persistent and nagging or more severe and sharp and accompanied by a loss of muscle strength and numbness in the affected leg.
Two forms of sciatica have been defined:
Acute sciatica: this describes an episode of sciatica that clears up within about 6 weeks. Sciatica treatment usually focuses on relieving pain and staying mobile.
Chronic sciatica: this is sciatica that lasts more than 6 weeks, or that recurs frequently. Treatment involves pain management and dealing with the underlying cause. You may in extreme cases need an operation to treat a slipped disc or to ease spinal stenosis.
When you first experience sciatica your treatment will include over-the-counter pain relief and exercise. Most people usually opt for either paracetamol or ibuprofen but if you find that these do not help after a couple of weeks, your GP may prescribe something stronger, such as codeine or diazepam, to relax your muscles. The latter is usually not given for more than a week because of the risk of addiction.
Although it is tempting to think that lying still is a helpful sciatica treatment, all the evidence suggests that this is almost the worst thing you can do. Keeping active and mobile will help you feel better, help you cope with the pain, relieve the pain and you will recover more quickly. Walking and swimming are particularly beneficial.
When the pain is troublesome, you can also try applying a compression pack that provides either heat or ice. Try both to see which one works best for you and then apply it either when you feel you need it, or twice a day.
If your sciatica continues for longer than 6 weeks, and is then regarded as chronic, exercising will still help but you need to see your GP for further advice. He or she can prescribe or recommend:
Stronger pain relief: paracetamol and codeine are often used together, or your doctor may prescribe an antidepressant, usually amitriptyline, or a type of drug commonly used in epilepsy, usually gabapentin. These drugs are thought to reduce nerve inflammation and to relieve pain due to nerve damage.
Steroid injections: if you have substantial inflammation, an injection of corticosteroids into the base of the back can also be used.
Physiotherapy: in addition to staying active, a physiotherapist can work with you to devise specific exercises to help increase your mobility and to reduce pressure on your sciatic nerve.
Cognitive behavioural therapy: this is a commonly used therapy for any type of chronic pain. It does not decrease the pain itself but it helps you to develop better coping strategies so that the pain does not have as great an impact on your everyday life.
Surgery is very much the last resort for any type of back pain, whatever the cause. It does, however, become necessary in some people with a slipped disc, or with degeneration of the spine. Spinal surgery involves a major operation that carries significant risks, as the surgeon is working close to the spine and the major nerves that originate from it, so it is only offered when all other possible treatment options have been exhausted.
The main types of surgery used as sciatica treatments are:
A discectomy: removal of part or all of a damaged vertebral disc.
Spinal fusion: immobilising two vertebrae together so that they no longer put pressure on the vertebral disc between them, or on the sciatic nerve.
Laminectomy: this involves widening the space between and within the bones of the spine so that there is more space for the sciatic nerve, and it is no longer under pressure.
Once you have had surgery, it is important to maintain an exercise program and to stay active. This will ensure that your muscles and ligaments are as strong as possible so that you can avoid further spinal problems and sciatica for as long as possible.
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