Practice Uncertainties

Which pain medications are effective for sciatica (radicular leg pain)?

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4248 (Published 12 October 2017) Cite this as: BMJ 2017;359:j4248
  1. Rafael Zambelli Pinto, lecturer,12,
  2. Annemieke J. H. Verwoerd, general practitioner and postdoctoral researcher,3,
  3. Bart W. Koes,, professor3
  1. 1Department of physical therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
  2. 2Graduate program in physical therapy, São Paulo State University (UNESP), Presidente Prudente, São Paulo, Brazil
  3. 3Department of general practice, Erasmus Medical Centre, Rotterdam, Netherlands
  1. Correspondence to R. Pinto rafaelzambelli{at}gmail.com

What you need to know

  • The most effective pain medication to treat patients with sciatica or radicular leg pain is unclear

  • In approximately one third of patients, symptoms improve within two weeks; in three quarters of patients, symptoms improve within 12 weeks, but about a third of patients have persistent and disabling symptoms after one year3

  • Medications used for the treatment of sciatica can have considerable side effects

Sciatica is commonly seen in primary care. Its prevalence in the general population varies between 3% and 14%, depending on the definition used.1 The prognosis of acute sciatica is generally favourable: data from a prospective study of 183 patients with a median disease duration of 16 days show that in approximately one third of patients, symptoms improve greatly (ie, measured on a 4 point scale, 1=worsened, 2=remained unchanged, 3=improved, and 4=improved greatly) within two weeks, and about three quarters of patients reported any improvement within 12 weeks.2 Nevertheless, in another study of 172 patients, 30% continued to report persistent and disabling symptoms after one year.3

Sciatica is a symptom rather than a specific diagnosis4 and is used broadly to refer to pain that radiates along the path of the sciatic nerve.5

The commonest cause of sciatica is impingement of lumbosacral nerve roots, as they emerge from the spinal canal, by a herniated intervertebral disc (fig 1). Other causes of impingement include spondylolisthesis and spinal tumours or cysts.4 For this reason, symptoms of sciatica often co-exist with low back pain, but disturbances along the course of the sciatic nerve can also arise from locations other than the lower back (ie, due to piriformis syndrome, diabetic radiculopathy, and hip fracture or dislocation).5

Fig 1 Common causes of sciatica. Disc herniation is the commonest cause. Spondylolisthesis can cause impingement

Patients with sciatica …

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