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Sciatica (lumbar radiculopathy) - Management
When should I refer someone with sciatica?
When assessing people for referral, consider that motor deficits and bowel or bladder disturbances are more reliable than sensory signs.
- If red flags suggest a serious condition:
- If there is progressive, persistent, or severe neurological deficit:
- Refer the person for neurosurgical or orthopaedic assessment (preferably to be seen within 1 week).
- If pain or disability remain problematic for more than a week or two:
- Consider early referral for physiotherapy or other physical therapy.
- Consider referral for assessment for an epidural injection of corticosteroid.
- If, after 6–8 weeks, sciatica is still disabling and distressing:
- If symptoms fail to respond with time, medication, and physiotherapy, refer the person to specialist low back pain and sciatica services (depending on local arrangements) for assessment, investigations, and opinion on injection and surgical interventions. Ideally, the person should be seen within 2 weeks.
- If pain or disability continue to be a problem despite appropriate pharmacotherapy and physical therapy, and if surgery is inappropriate or has failed to improve symptoms:
- Consider referral to a multidisciplinary back pain service or a chronic pain clinic.
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