What Is Sciatica, and How Is It Treated?

Back pain is very common. Nearly 80% of people will have some form of back pain at least once in their lives. Sciatica is a specific kind of back pain that starts in the lower back and travels down the leg. In severe cases, it can impact your quality of life. Fortunately, there are sciatica treatments that can help treat your symptoms and offer you some relief. 

Let’s take a closer look at what sciatica is, how to know you have it, and how you can treat it.   

What is sciatica?

Sciatica is a type of back and leg pain caused by compression or irritation of the sciatic nerve. The sciatic nerve is the largest nerve in your body. At about 2 cm wide, it has the width of a penny. Your sciatic nerve starts at the lower end of your spinal cord, in the small of your back and travels down your leg. The nerve splits into your tibial and common peroneal nerves, which provide feeling and movement to your lower leg. Anything that compresses your sciatic nerve as it exits the lower spine or courses down into your leg can cause sciatica.  

Treatments for sciatica target the cause or focus on treating the pain or inflammation.

Medications for sciatica

There are many different medications that treat sciatica. Let’s review the common types of sciatica treatment below.

Nonsteroidal anti-inflammatory drugs 

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve) are often the go-to choice for managing sciatica. These medications work by reducing inflammation around the sciatic nerve. They’re available over the counter, but prescription-strength versions are also used when symptoms are more severe.

Acetaminophen (Tylenol)

Acetaminophen is an over-the-counter (OTC) pain medication that can relieve mild to moderate pain from sciatica. It doesn’t have a lot of side effects so it can be a good alternative for people who can’t take NSAIDs because of stomach or kidney issues. Acetaminophen doesn’t reduce inflammation like NSAIDs do though. So while it can help with your pain, it won’t actually help your sciatica heal.

Oral corticosteroids

A short course of steroids like prednisone or methylprednisolone can be prescribed to calm inflammation in your lower back. Corticosteroids have lots of side effects though, so it’s best not to use them for the long term. They’re most often used when the pain isn’t improving with other treatments or when your healthcare team can’t prescribe you other medications for medical reasons.

Muscle relaxants

If muscle spasms are also a factor in your pain, medications like cyclobenzaprine (Flexeril) or methocarbamol (Robaxin) can help. These medications work by relaxing tense muscles, which can reduce pressure on the sciatic nerve. Drowsiness is a common side effect, so muscle relaxants are usually recommended at night. You should also avoid alcohol when using any muscle relaxer.

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• Sciatica stretches: Moving your body can help relieve sciatica. These stretches can help relieve your sciatica pain.

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Neuropathic pain medications

Neuropathic medications are a group of medications that specifically treat pain caused by your nerves. Because sciatica is a condition affecting your sciatic nerve, it makes neuropathic pain medications a reasonable choice. 

Medications like gabapentin (Neurontin) and pregabalin (Lyrica) can help treat sciatica. They may work for the burning, tingling, or shooting sensations of sciatica. These medications work by calming overactive nerve signals. They are often used when pain becomes chronic or persistent.

Tricyclic antidepressants 

Tricyclic antidepressants (TCAs) like amitriptyline are sometimes usedto manage nerve pain, including sciatica. These older antidepressants affect the way the brain and spinal cord process pain signals. These medications aren’t commonly a first choice. But they may be helpful when other options haven’t provided enough relief.

Opioids

Opioid pain medications are sometimes used in the short term for severe pain that interferes with daily activities or sleep. However, due to the risks of dependence, constipation, and other side effects, they’re typically not used long term. A healthcare professional might consider them when other treatments haven’t worked.

Topical treatments

Topical products like lidocaine patches or capsaicin cream may provide some localized relief. They aren’t always effective for deep nerve pain, though, and are often used in addition to other treatments rather than alone. These medications generally don’t interact with other medications and have few side effects. This can make them helpful if your healthcare team prescribes you several medications.

Physical therapy

Physical therapy is one of the most effective treatments for sciatica. A licensed physical therapist can guide you through exercises that help sciatica by:

• Strengthening your core and back muscles

• Improving flexibility

• Reducing pressure on the sciatic nerve

The goal isn’t just to relieve pain, but also to correct any underlying issues that may be causing your pain. Over time, physical therapy can help improve mobility and prevent future flare-ups. 

Many people start to notice improvement within a few weeks. A structured home exercise program can help you maintain long-term results. Physical therapy is often recommended alongside medications and lifestyle strategies as part of a comprehensive care plan.

Steroid injections

Epidural steroid injections may be an option when sciatica pain is severe or doesn’t improve with other therapies. This treatment works by placing a corticosteroid directly into the space around the irritated nerve. This helps to lower inflammation.

Relief from steroid injections can be significant, but it varies from person to person. Some people feel better for weeks or months, while other people may need repeat injections. Steroid injections are generally safe, but you shouldn’t get them more than a few times per year.

Surgery

Surgery is typically a last resort for sciatica and should be considered only when other treatments haven’t worked. The most common surgical procedure is called a discectomy. This is when a surgeon removes part of the disc in your back that’s pressing on your sciatic nerve. Another surgical procedure that can be performed for sciatica is a laminectomy. A laminectomy widens the spinal canal to help relieve pressure on the sciatic nerve. 

While surgery can have a high success rate, it’s important to weigh the pros and cons carefully. Surgery for sciatica can have a long recovery period and involves risks like infection and bleeding. And most people with sciatica improve without surgery anyway. Surgery is recommended only when absolutely necessary.

Massage

Massage therapy may help relieve muscle tension. It can also improve blood flow, reduce stress, and promote relaxation — all of which can contribute to pain relief. Massage won’t fix structural issues like a herniated disc. But it may be helpful when combined with other treatments, especially during flare-ups.

Some people with sciatica find that certain therapies provide noticeable relief. These therapies include:

• Deep tissue massage

• Trigger point therapy

• Myofascial release 

Just be sure to work with a licensed massage therapist who has experience with nerve-related conditions. You will also want to avoid overly aggressive techniques that could worsen your symptoms.

Acupuncture

Acupuncture is a technique that involves inserting thin needles into specific points on the body. The science is still evolving on why it works. But some studies suggest acupuncture helps to reduce sciatica pain by promoting the release of endorphins. These are the body’s natural painkillers.

Acupuncture is generally considered safe when performed by a licensed practitioner. It might not work for everyone. But acupuncture can be worth trying if other treatments haven’t provided you with enough relief, or you’re looking for other options.

OTC and home remedies

Sciatica can usually be treated at home with OTC medications, especially when it’s mild. Common choices include NSAIDs and acetaminophen. Other home remedies to help ease inflammation and muscle tension include:

• Applying ice

• Doing gentle stretching

• Staying active to avoid prolonged sitting or bed rest

• Using supportive cushions while sitting

• Maintaining good posture

• Doing low-impact exercise, like walking or swimming

While these strategies aren’t a cure, they can be surprisingly effective when used consistently. And they can also support recovery and prevent recurrence of sciatica pain.

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Written by:

Kelly Elterman, MD

Kelly Elterman, MD, is a board-certified anesthesiologist by the American Board of Anesthesiologyand has been practicing clinically since she finished her residency training in 2013. Along with her training, she has over 10 years experience in anesthesiology.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Farzon A. Nahvi, MD

Farzon Nahvi, MD, is an emergency medicine physician and author of “Code Gray: Death, Life, and Uncertainty in the ER.” He works at Concord Hospital in Concord, New Hampshire, and teaches at the Geisel School of Medicine at Dartmouth.

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