Sciatica medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
Treatment of the underlying cause of the compression is often the most effective course. When the cause is due to a prolapsed or lumbar disc herniation, research has shown that, with supportive treatment to help relieve pain, 90% of disc prolapse will recover with no specific intervention. Genetics appear to influence the risk of developing disc herniation.
Physical therapy and rehabilitation include passive treatments and therapeutic exercises customized to meet the patient's individual needs. Physical therapists work one-on-one with the patient to reduce pain, increase flexibility, and build strength.
Most cases of sciatica can be effectively treated by one or a combination of the following:
Medication therapies
- Anti-inflammatory medications (i.e. NSAIDs or oral steroids). If pain is severe, the doctor may prescribe a more potent NSAID. Chronic sciatica may require a muscle relaxant and/or anti-depressant medication. Certain anti-seizure and anti-depressant medications are effective in blocking pain messages sent to the brain. Some of these drugs may enhance the body's production of natural pain killers - endorphins.
- Pain medications (e.g. acetaminophen)
- Gabapentinoids are not effect.[1]
Epidural steroid injections
Epidural steroid injections to deliver local anti-inflammatory agents (and possibly a pain medication) directly to the affected area. This type of spinal injection places a steroid (corticosteroid) medication near spinal nerve roots.
A systematic review concluded that "the available evidence suggests that Epidural steroid injections|epidural corticosteroid injections offer only short-term relief of leg pain and disability for patients with sciatica. The small size of the treatment effects, however, raises questions about the clinical utility of this procedure in the target population."[2]
References
- ↑ GitHub Contributors. Sciatica treatment with gabapentinoids: a living systematic review. GitHub. Available at https://github.com/openMetaAnalysis/Sciatica-treatment-with-gabapentinoids/blob/master/README.md. Accessed April 23, 2017.
- ↑ Pinto RZ, Maher CG, Ferreira ML, Hancock M, Oliveira VC, McLachlan AJ; et al. (2012). "Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis". Ann Intern Med. 157 (12): 865–77. PMID 23362516. Review in: Ann Intern Med. 2013 May 21;158(10):JC7