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Conservative care
There are a number of conservative treatment options available to help
alleviate the pain and discomfort of sciatic pain.
Heat/ice
For acute sciatica pain, heat and ice packs are quite often the first step
to try for relief. 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.
Medications
Over-the-counter or prescription medications may also be helpful in
relieving sciatica pain. Non-steroidal anti- inflammatory drugs (NSAIDs) or
oral steroids can be used to reduce the inflammation and pain.
Epidural steroid injections
If the pain is severe, an epidural injection can be performed to reduce the
inflammation. An epidural 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 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
Treatment with 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 back.
Surgical treatments
If the 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 sciatic pain, one of two surgical procedures may be
considered: a microdecompression (microdiscectomy) or an open decompression
(lumbar laminectomy).
Microdiscectomy (microdecompression)
In cases where the 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 pain
after this type of surgery.
Lumbar laminectomy (open decompression)
If the sciatica is associated with spinal stenosis, surgery may be offered
as an option if the patient’s ability to maintain a normal level of
activity falls to an unacceptable level. Again, surgery is elective and
need only be considered for those patients who have not gotten better after
conservative treatments. After a lumbar laminectomy (open decompression),
approximately 70% to 80% of patients experience relief from their pain.
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