5 Ways to Take the Sting Out of Sciatica

Peter Jaret | Jul 14th 2017

Reviewed by John Edward Swartzberg, M.D.

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The largest nerve in the body

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Sciatica is radiating pain, tingling, or numbness that follows the sciatic nerve—the largest nerve in the body—which runs from the lower back and down the back of each leg. The most common cause is a herniated disc, which bulges and presses on the sciatic nerve.

Sciatica can be severely debilitating if the pain becomes chronic, causing weakness and numbness in the affected leg, making it difficult to stand.

Many people with sciatica would try almost anything for relief, yet few medical treatments have proved to be effective in easing sciatica’s hallmark searing or stabbing pain. Thankfully, there are some ways to find relief. Here are seven remedies to try, and how you can prevent flare-ups.

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1. Wait it out

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That’s not easy advice to take when you’re in pain. But most flare-ups of sciatica go away on their own. According to the American Academy of Orthopedic Surgeons, 80 to 90 percent of patients with sciatica get better without surgery, typically within several weeks.

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2. Apply ice, then heat

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Applying a cold pack or a heating pad to the affected area may help. First, try icing the area for 20 minutes several times a day. If pain continues after two or three days, switch to heat.

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3. Take an over-the-counter pain reliever

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Acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), or aspirin, may temporarily ease pain. But check with your doctor before taking NSAIDs; in older adults, they can increase the risk of stomach irritation and bleeding ulcers, raise blood pressure, and affect the kidneys.

Some doctors have turned to off-label prescribing of the nerve pain medication pregabalin (Lyrica) to ease sciatica, hoping the drug would relieve symptoms in the same way it helps relieve types of pain caused by nerve damage, such as diabetic neuropathy. But a new study has crushed those hopes. In a trial that involved 209 patients with sciatica, volunteers taking pregabalin fared no better than patients given a placebo pill, according to findings published in The New England Journal of Medicine in March 2017. And since the drug has side effects, ranging from dizziness, blurred vision, and drowsiness to changes in sexual function, the best advice is not to take pregabalin for sciatica.

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4. Get up and move

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Moving around helps reduce inflammation and may make you feel better overall. Try walking and doing simple stretching exercises. Yoga, Pilates, and similar therapies might also help, although few good studies have been done. If symptoms persist for three weeks or longer, ask your doctor whether physical therapy may be an option.

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5. Get a good night’s sleep

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Sleepless nights can leave you exhausted and make sciatica feel even worse. Avoid caffeinated beverages and alcohol. To relieve pressure on the sciatic nerve while you sleep, lie on your side with a pillow between your knees or on your back with a pillow or two under your knees.

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What your doctor may suggest

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If conservative treatment hasn’t improved symptoms over six weeks, and persistent sciatica begins to interfere with your everyday life, injecting a steroid drug into the affected spinal area might reduce inflammation and pain, although the results are typically short-lived. In a study in the Journal of Clinical and Diagnostic Research in February 2017, researchers compared 47 patients who received spinal injections with 46 who received a placebo injection of saltwater. Four weeks after the treatment, patients who received the steroid injection reported less pain than those in the placebo group. But by the twelfth week, there was no difference between the two groups.

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Limited benefits of surgery

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If you still have disabling pain after three months, your doctor may recommend surgery if a herniated disc is causing your sciatica. But the benefits may not be long-lasting. In a 2016 analysis in the European Journal of Pain, researchers found that the benefits of surgery were most impressive during the first three months after the procedure. Five years later, most patients were still reporting sciatica pain and discomfort.

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How to keep sciatica at bay

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Unfortunately, there’s no magic bullet for treating persistent sciatica. Staying active can help ease the pain and may prevent flare-ups. Protecting your lower back by finding comfortable positions that don’t put stress on your spine — sitting up straight with a lumbar pillow for support, for instance — may also help prevent the sciatic nerve from becoming irritated and inflamed. If you have to sit for long stretches, take frequent short breaks to get up and walk around.