The use of prescription medication for sciatica is being discouraged while natural treatments/therapies are becoming the new standard. This is currently happening in the United Kingdom and its National Institute for Health and Care Excellence. The focus is to reduce the use of medication for sciatica and aim for natural treatments unless absolutely necessary. This is to help reduce the opioid epidemic, along with reducing the use of medications and their negative side effects that cause other conditions and illnesses.
The National Institute for Health Care Excellence has updated its guidelines with specific language that discourages the use of multiple classes of drugs for various ailments/conditions like sciatica. The United States has already set up similar guidelines limiting the use of prescription medications for sciatica until after a regimen of non-pharmacological treatment/therapies like physical therapy, chiropractic, acupuncture, massage, etc. If no improvement is seen in four to six months then medication can be administered.
The guidelines say that individuals with acute or chronic sciatica should not be given gabapentinoids, this is a class of drugs designed to treat seizures, other antiepileptics, oral corticosteroids, and opioids. They also report that there is no evidence on the use of antidepressants for sciatica. However, it is recognized that it can benefit some individuals but should not just be handed out for every case.
Medication for Sciatica
Medication does work for sciatica. It's the side effects and addiction issues they are trying to avoid. Options include:
- Nonsteroidal anti-inflammatory drugs
- Gabapentinoids
- Corticosteroids
- Benzodiazepines
Opioids have been overprescribed for all types of pain. However, they don’t help in repairing the damaged/pinched nerves and only relieve/sedate the pain symptoms. In addition side effects like confusion, dizziness, and sleep problems are increased leading to more health issues.
Treatment Options
When it comes to acute pain over the counter medications, NSAIDs, oral steroids, and gabapenitoids can be recommended for a brief period and not long term. This is just to settle the pain until a non-medication treatment plan is developed to realign, adjust, and restore the sciatic nerve to its proper position. A physician or physical therapist/chiropractor can diagnose the difference between actual sciatica and low back pain.
Physical Therapy and Chiropractic
Chiropractic treatment and physical therapy for sciatica first look to determine the cause of the condition and how the individual spends their day as far as do they sit or stand for a good portion of the day along with the types of activities like lifting, bending, stretching, twisting, etc.
The nerves are irritated and send signals to the brain. This could be tingling with pain, numbness, or a combination. The body wants to protect itself. Once the source of irritation is identified the chiropractor or physical therapist works with the patient to workout/massage/release the muscles, ligaments, joints to work the sciatic nerve back to full health and function.
The chiropractor/therapist challenges the nerve to get back into proper form in a safe fashion. How the condition resolves depends if it’s acute or chronic. In acute cases, the pain level is higher but is easier to treat. The faster chiropractic and physical therapy intervention are sought out the better the odds additional treatment will not be required. The first sessions of chiropractic and physical therapy are designed to calm the system down. Then the body will begin to heal itself within about four weeks without medication.
Conservative Therapy
Preference for non-surgical treatment is the way to go whenever possible. Only when significant weakness in the leg or foot from nerve compression, surgery could be necessary. It can become an emergency situation if there is numbness around the groin and if it affects bowel or bladder function. Six to eight weeks of conservative treatment is the key. And if no improvement correlated with an MRI is achieved, then surgical treatment could be the next phase of treatment.
Education About Sciatica
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