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Treatments and drugs
By Mayo Clinic staffFor most people, sciatica responds well to self-care measures. These may include use of alternating cold packs and hot packs, stretching, exercise, and use of over-the-counter (OTC) medications. Beyond the self-care measures you may have taken, your doctor may recommend the following:
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Physical therapy. If you have a herniated disk, physical therapy can play a vital role in your recovery. Once acute pain improves, your doctor or a physical therapist can design a rehabilitation program to help prevent recurrent injuries.
Rehabilitation typically includes exercises to help correct your posture, strengthen the muscles supporting your back and improve your flexibility. Your doctor will have you start physical therapy, exercise or both as early as possible. It's the cornerstone of your treatment program and should become part of your permanent routine at home.
- Prescription drugs. In some cases, your doctor may prescribe an anti-inflammatory medication along with a muscle relaxant. Narcotics also may be prescribed for short-term pain relief. Tricyclic antidepressants and anticonvulsant drugs also can help ease chronic pain. They may help by blocking pain messages to the brain or by enhancing the production of endorphins, your body's natural painkillers.
More aggressive treatments
When conservative measures don't alleviate your pain within a few months, one of the following may be an option for sciatica treatment:
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Epidural steroid injections. In some cases, your doctor may recommend injection of a corticosteroid medication into the affected area. Corticosteroids suppress inflammation around the irritated nerve, thereby helping to relieve pain.
Their usefulness in treating sciatica remains a matter of debate. Some research has found that corticosteroids can provide short-term symptom relief but that these medications aren't a long-term solution. In addition, corticosteroids can have side effects, so the number of injections you can receive is limited. If your doctor recommends corticosteroids, he or she will determine a safe course of injections for you.
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Surgery. This is usually reserved for times when the compressed nerve causes significant weakness, bowel or bladder incontinence or when you have pain that gets progressively worse or doesn't improve with other therapies.
Surgical options include diskectomy and microdiskectomy. In diskectomy, surgeons remove a portion of a herniated disk that's pressing on a nerve. Ideally, most of the disk is left intact to preserve as much of the normal anatomy as possible. Sometimes a surgeon will perform this operation through a small incision while looking through a microscope (microdiskectomy).
Success rates of standard diskectomy and microdiskectomy are about equal, but you may have less pain and recover more quickly with microdiskectomy. Discuss which option might be best for you with your doctor, and carefully weigh the potential benefits of surgery against the risks.
- Lin M. Musculoskeletal back pain. In: Marx JA, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo.: Mosby; 2006. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-0-323-05472-0..00051-7--s0045&displayedEid=4-u1.0-B978-0-323-05472-0..00051-7--s0060&uniq=184337872&isbn=978-0-323-05472-0&sid=955285604. Accessed March 1, 2010.
- Rosenbaum RB, et al. Degenerative disease of the spine. In: Bradley WG. Neurology in Clinical Practice. 5th ed. Burlington, MA: Butterworth-Heinemann; 2008. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-0-7506-7525-3..50115-1--cesec38&displayedEid=4-u1.0-B978-0-7506-7525-3..50115-1--cesec55&uniq=184337872&isbn=978-0-7506-7525-3&sid=955285604. Accessed March 1, 2010.
- Gregory DS, et al. Acute lumbar disk pain: Navigating evaluation and treatment choices. American Family Physician. 2008;78:835.
- Aminoff MJ. Mechanical and other lesions of the spine, nerve roots, and spinal cord. In: Goldman L, et al., eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/184337872-18/0/1492/1420.html#4-u1.0-B978-1-4160-2805-5..50428-6--cesec37_17875. Accessed March 1, 2010.
- Devereaux M. Low back pain. Medical Clinics of North America. 2009;93:477.
- Low back pain fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm#119483102. Accessed March 1, 2010.
- Wheeler SG, et al. Approach to the diagnosis and evaluation of low back pain in adults. http://www.uptodate.com/home/index.html. Accessed March 1, 2010.
- Knight CL, et al. Treatment of acute low back pain. http://www.uptodate.com/home/index.html. Accessed March 1, 2010.
- Ernst E. Complementary treatments in rheumatic diseases. Rheumatic Disease Clinics of North America. 2008;34:455.
- Chronic pain: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm. Accessed March 1, 2010.
- Laskowski ER (expert opinion). Mayo Clinic, Rochester, Minn. March 4, 2010.
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