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

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

Patients with sciatica …