Drugs, Medications, and Spinal Injections to Relieve Sciatica

If you’ve been diagnosed with sciatica, after reviewing your symptoms and overall health, your doctor may talk with you about certain medications or spinal injections to treat your condition. The type of non-surgical sciatica treatment you’ll discuss depends on the cause of your sciatica, pain severity, and outcome of other therapies you've tried. These are some of the common choices your doctor may bring up.

Non-steroidal anti-inflammatory drugs are used to reduce swelling while relieving your pain. They do not target sciatica pain specifically, but in lowering inflammation throughout the body, it may help with sciatic pain. Your doctor may recommend aspirin, ibuprofen (Advil) or naproxen (Aleve).

Because long-term use of NSAIDs can carry a risk of serious side effects, such as gastrointestinal bleeding, heart attack or stroke, and kidney damage, they aren’t suitable for managing chronic pain. If a person is at high risk of any of these conditions, Wesley Bronson, M.D., a spine surgeon at Mount Sinai Health System in New York City, recommends trying a different over-the-counter pain med like acetaminophen (Tylenol) or a muscle relaxant.

"There are lots of patients who may be on blood thinners or they can’t take NSAIDs because of other medications they're taking,” he says. “That can make sciatica more difficult to treat.”

Skin patches or topicals—think Aspercreme, Biofreeze, or Icy Hot—are used for muscle pain relief and may help with sciatic pain when you apply them directly over the painful area. One of the most common options, lidocaine patches, are generally used for pain relief in the lower back.

However, Dr. Bronson says that these topicals, which are available over the counter, “aren’t particularly effective at treating nerve-related pain, because the origin of that nerve related pain is within the spinal canal. Topical treatments are not likely to penetrate that deep to be effective for that kind of pain.” That’s backed up by a meta-analysis in Cochrane Database of Systematic Reviews which found that topical NSAIDs are more likely to ease the pain of muscle sprains and strains, or hand and knee osteoarthritis, than sciatica pain.

Still, you may experience some relief via OTC topicals and patches, since sciatica can cause muscles around the affected area to tense up, exacerbating your pain, says Benjamin Bjerke, M.D., an orthopedic spine surgeon in Jeffersonville, IN. A nonprescription 4% lidocaine patch, like Aspercreme and Salonpas, is the most common type used for short-term, minor back pain. It can be used up to three times a day, for a maximum of eight hours each. Apply it to clean, dry skin with no cuts or irritation.

It’s best to avoid applying lidocaine patches to areas where they’re likely to be rubbed off by clothes or exposed to a source of direct heat. After applying the patch wash your hands and avoid exposing the patches to your eyes, since direct contact with the chemicals can cause irritation.

If you have chronic sciatica and NSAIDs aren’t doing the trick, you may need a muscle relaxant to help ease muscle spasms. Per the American Family Physician, muscle relaxants encompass a wide range of medications used in the treatment of conditions that cause chronic muscle problems. The most common of these include:

• Dantrium (dantrolene)

• Lioresal (baclofen)

• Zanaflex (tizanidine)

These can be useful for treatment of both lower back pain and nerve pain in the legs and buttocks, as this allows the painful muscles to be stretched out without severe pain. While muscle relaxants obviously don’t treat nerve pain, they have an indirect beneficial effect by allowing tight muscles that are contributing to sciatic pain in the lower back pain and nerve pain in the legs and buttocks to be stretched out for temporary relief.

Muscle relaxants are usually only used for acute treatment, as adverse side effects are common, including sedation and dizziness. The broad range of medications that fall under this category mean that there is an equally broad range of possible side effects. Dantrolene, for example, has been known to cause life-threatening liver problems.

For especially severe or treatment resistant pain, oral opioid analgesics may be prescribed for short-term use. They might also be used when NSAIDs or other OTC analgesics are too risky or ineffective, per research in Clinics in Orthopedic Surgery. These are not used for long-term management because of the risk of dependency, which is known to become an issue when they are used for more than five days at a time.

Other side effects from oral opioid analgesics include fluid build-up, high blood pressure, mood disturbances, and digestive issues.

Certain antidepressant drugs may be prescribed for sciatica because they help block pain messages on their way to the brain. They may also help increase your body's production of endorphins—a natural pain killer. Much is still unknown, though, about the effectiveness of these drugs for sciatica pain: Per a 2021 meta-analysis in BMJ, tricyclic antidepressants (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) might be effective for back pain, but more evidence is needed.

Aside from the pain-relieving effects, these medications may also offer relief from the mood-related symptoms of depression, which often appears with chronic pain conditions like sciatica. Side effects include drowsiness, dizziness, dry mouth, and constipation.

For nerve pain associated with sciatica, anticonvulsant medications, also used to treat depression, were once a staple, but have fallen out of favor, per a review in the Canadian Medical Journal, because of significant and debilitating side effects, including fatigue, dizziness, sedation, and diarrhea. Example of these drugs include Neurontin (gabapentin) and Lyrica (pregabalin).

If your sciatic pain persist, your doctor may talk with you about steroids, which reduce inflammation, to ease your discomfort. With an epidural steroid injection, a corticosteroid medicine is injected near the spinal nerve roots. These injections can reduce pain for months and sometimes longer. However, epidural steroid injections aren't effective for all patients.

As with any treatment, it’s important to follow your doctor's advice precisely, for effectiveness as well as safety. Never mix over-the-counter and prescribed drugs without consulting your doctor. And let your doctor know about all other medications you're taking (and even which vitamins and supplements you take) to make sure there are no unexpected interactions.

Obviously, the goal of using medications with sciatica is to provide pain relief. But medications alone cannot address the root cause of your sciatic pain—in other words, they don’t heal or cure whatever condition is leading to sciatica. Talk with your doctor about figuring out the cause of your sciatic pain, and how you can treat it. Meanwhile, explore alternative or additional ways to lessen your discomfort, like physical therapy or exercises that help address the sciatic nerve compression.