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Sciatica (lumbar radiculopathy) - Management
Overview of management

  • Check for red flags indicating serious conditions such as cauda equina syndrome, spinal fracture, cancer, or infection; if any red flags are present, admit or refer the person with appropriate urgency.
  • Provide information and advice to foster a positive attitude and realistic expectations.
    • Sciatica settles within 6–12 weeks in most people, but symptoms can persist for months.
    • The goals for treatment are to relieve the pain and to allow a return to usual activities as soon as possible — there is no need to wait until the pain has completely gone before resuming usual activities and work.
  • Provide adequate analgesia to manage the pain and to help the person keep active.
    • For first-line analgesia, offer paracetamol (preferred) or a nonsteroidal anti-inflammatory drug (NSAID).
    • For additional analgesia, suggest paracetamol combined with an NSAID, or offer a weak opioid such as codeine, dihydrocodeine, or tramadol.
    • For more potent analgesia, consider offering a short course of a strong opioid (such as morphine). If the use of a strong opioid is becoming chronic, or if doses are escalating, refer to, or seek advice from, a pain clinic or other specialist service.
  • If the paraspinal muscles are in spasm:
    • Consider offering a short course of a benzodiazepine such as diazepam.
    • Consider advising a trial of hot packs over the muscle.
  • If sciatic pain does not respond to additional analgesics:
    • Consider offering a trial of a tricyclic antidepressant (such as amitriptyline) or gabapentin.
    • Offer referral for physiotherapy.
  • Use clinical judgement to decide if and when to follow up.
    • Many people are appropriately invited to return only when necessary. Routine follow up may be appropriate for people with psychosocial risk factors.
    • When following up, review the person's diagnosis and assess their response to treatment; manage accordingly.

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