Medications for Sciatic Pain
As with most back pain, doctors are often reluctant to prescribe medications to treat sciatica. Studies of sciatic patients have had mixed results, with no one medication clearly helping more than another.
On the other hand, research has repeatedly found that back pain (including sciatica) responds well to physical therapy and self-care. Bed rest is often avoided, as it has been shown to have no effect above normal activity.[2,3,10]
I am not a doctor, but I have had extensive experience with sciatica (nearly 30 years) and these medications. These days I'm mostly sciatic-pain-free with targeted stretches and physical therapy. I still have a handful of painful days each year, but I no experience the continuing agony I once had.
What is sciatica?
The sciatic nerve runs from the spine and lower back, through the hip and buttock area, down the thighs and ends in the feet.
Sciatic pain is caused by compression of the sciatic nerve root in the lumbar spine region or inflammation around the region where it branches from the spine.
Spiking or aching pain, numbness and tingling can be felt anywhere along the nerve, even if though it is most commonly irritated in the lower back.
Finding the cause of the pain
It is important that the underlying cause of sciatica be found, as treatment can differ.
Ask your doctor to search for an underlying cause. If they don't listen to you, find another doctor if you can. Your pain should be taken seriously!
I have had sciatica from inflammation of the soft tissues for over 20 years.
From my early teens, it would flare up regularly and make it impossible for me to sit for long periods or exercise without debilitating pain. Doctors found only soft-tissue inflammation, caused by poor carrying and lifting posture.
For me, anti-inflammatory medications were useful to treat acute pain at the beginning of a sciatic flare, and hide the longer term pain without fixing the problem. But these medications caused long-term kidney damage.
When they discovered my damaged kidneys, I was taken off all anti-inflammatory medications - I had to seek other solutions.
A variety of natural methods and lifestyle changes has helped me to control and nearly eliminate my sciatica.
Most recently, doctors discovered I have spondyloarthritis and have had it for decades. They said that this was the cause of the sciatic pain, even when I was a teen.
Causes of sciatica
- slipped or bulging disc
- narrowing of the spinal canal (lumbar spinal stenosis)
- soft tissue or bone injury near the sciatic nerve
- arthritis in the spine (spondyloarthritis)
- piriformis syndrome (the sciatic nerve runs through the piriformis muscle instead of underneath)
- poor posture caused by a number of reasons (carrying bags on one shoulder, pregnancy, being overweight, regular use of high heels, a soft mattress, etc.)
All of the medications used to 'treat' sciatica aim to reduce pain, and some to reduce inflammation.
These medications reduce the severity of the symptoms, but they do not fix the underlying cause, and they often introduce negative side effects.[5,6,7]
The type of medication should be chosen based on the underlying cause of the pain—please see your doctor and undergo various tests to find the cause!
All of these medications can react badly with alcohol and other medications.
Always read instructions carefully, and ask your doctor or pharmacist for more information.
Sciatica medications at a glance
Common Side Effects
stomach, digestion, heart, liver, kidney, skin, dizziness
NSAIDs (injection / intravenous)
stomach++, digestion++, heart, liver, kidney++, skin++, dizziness, drowsiness and more
COX-2 inhibitors (NSAID)
heart++, liver, kidney, skin, dizziness
stomach, kidney, anemia, tinnitis
stomach, kidney, liver
Narcotics (opiates / opioids)
digestion, immune system, skin, drowsiness, addiction, tolerance
stomach, digestion, skin, drowsiness, dependance
stomach, kidney, digestion, drowsiness, dizziness
stomach, skin, drowsiness, dizziness, addiction, dependence, tolerance
skin, drowsiness, dizziness, weight gain, dependence
Corticosteroid epidural injection
low blood pressure, drowsiness, dizziness, muscle weakness
Note: I have used the chemical compound names throughout this article. The same medications are sold with so many different trade names around the world. Please check your medication packet to see what actual ingredients it contains.
Sciatic medications in detail
In this section, we will take a closer look at the various medications that are used to treat sciatica pain. We will also learn about possible side effects that are associated with long-term use. These are the medications I will address:
- NSAIDs (non-steroidal anti-inflammatory medications)
- Intravenous or injected NSAIDs
- COX-2 inhibitors (NSAID)
- Aspirin (NSAID)
- Acetominophen (paracetamol)
- Narcotics (opiates and opioids)
- Muscle relaxants
- Gabapentin (anti-convulsant)
- Corticosteroid epidural injections (only used for severe cases caused by spinal problems)
Non-steroidal anti-inflammatory drugs (NSAIDs) are most commonly prescribed for short term treatment of sciatic pain, and are the first prescription choice of most doctors.
Ibuprofen and aspirin are both recommended, because they have the fewest and least severe side effects, although many others are prescribed for short term treatment.
NSAIDs work by reducing the inflammation in soft tissue, reducing the pressure on the sciatic nerve, and providing some pain relief.
Warnings: IBS or stomach ulcer patients, people with kidney damage or reduced kidney function, should not use any NSAIDs.
Asthma or high-blood pressure sufferers should speak to their doctor before taking NSAIDs.
Traditional NSAIDs used to treat sciatica: ibuprofen, naproxen, diclofenac, cyclobenzaprine, nabumetone, indomethacin, ketoprofen, tolmetin, flurbiprofen, meloxicam, phenylbutazone.
Diclofenac may be recommended for topical application (Voltaren) to treat sciatic, lower back, hip, buttock and leg pain, caused by muscle inflammation.
Although these are effective in the short term against acute sciatica, all NSAIDs have side effects, some potentially quite severe in the longer term.[1,7,8]
- Long-term use raises the risks of heart attacks.
- They are one of the most common causes of stomach ulcers and bleeding throughout the digestive system. They often cause nausea and reflux, which is why you should never have any NSAID on an empty stomach.
- Used short term, they decrease kidney function, and long term use results in irreparable liver and kidney damage.
- NSAIDs may cause diarrhea or constipation.
- Some people find their skin bruises or rashes, or their extremities may swell (fluid retention).
- Headaches, dizziness and high blood pressure are also common side effects.
Injected / intravenous NSAIDs
Some NSAIDs, can be injected into the sciatic region, or given to patients intravenously (via an IV drip), to provide fast acting, short term relief from the pain and inflammation.
NSAID injections are typically used in acute and extremely painful cases, especially when walking and lack of muscle control is a problem.
Ketorolac or meloxicam can be injected or given intravenously in hospitals, and may be given as follow-up tablets to reduce for severe inflammation and pain. Treatment is usually limited to five days.
In most countries, NSAID injections are only provided by hospitals, under observation, because of the high risk of severe side effects, which increase with longer term use.
Warning: patients with high blood pressure, heart problems, or kidney problems should not be given injected or intravenous NSAIDs.
In addition to all of the usual side effects caused by tablet-form NSAIDs, injected or intravenous NSAIDs can many serious complications:
- Water retention and severe swelling is common, as are skin rashes. Severe bruising is also possible. Asthma patients may find fluid builds up in the lungs.
- Many people have reported hallucinations, tremors and convulsions.
- Stomach and digestion problems can be more severe than with tablet NSAIDs, with broken walls (perforation) and intestinal bleeding reported.
- Kidneys are damaged more quickly and more severely than with other NSAIDs, with kidney failure being the worst case.
COX-2 Inhibitors - NSAID
Celecoxib (Celebrex), closely related to traditional NSAIDs, is occasionally used to treat sciatic pain caused by arthritis, avoiding the normal gastric effects caused by standard NSAIDs.
However, its use is controversial after other coxibs were withdrawn due to heart health risks (rofecoxib - Vioxx, valdecoxib - Bextra).
In addition to all of the side effects of normal NSAIDs (apart from the stomach ulceration/bleeding), like other coxibs, celecoxib has a much higher risk of heart attacks and strokes.
Personally, I had no improvement in my sciatic symptoms when taking celecoxib.
Did you know?
Willow bark, containing salicylic acid, was recorded as a medicinal plant in ancient Sumer (approximately 2000 BC). The first recorded use specifically against pain was in ancient Egypt in 1543 BC.
Acetylsalicylic acid (later named aspirin) was first produced in a laboratory in 1853 by French chemist Charles Frédéric Gerhardt.
Aspirin - NSAID
Aspirin (acetylsalicylic acid) is made from one of the oldest pain relieving compounds discovered - willow bark, containing salicylic acid.
Aspirin is in a different class of NSAIDs with both mild pain relieving and anti-inflammatory properties.
Aspirin works by limiting the transmission of pain signals, reducing inflammation and improving blood flow by thinning the blood.
This milder medication has fewer side effects, usually occurring with long term or heavy use.
- As with other NSAIDs, you can have stomach problems - nausea, ulcers.
- Aspirin does reduce kidney function with short term use.
- Large doses have been reported to cause anemia and tinnitus.
Paracetamol (acetominophen) is one of the most common and safest medications used against mild pain.
Many doctors prefer prescribing acetominophen first as a treatment for sciatica, before using NSAIDs, which have more side effects.[1,10]
It doesn't significantly reduce inflammation, and is therefore not considered an NSAID. It is also much safer than NSAIDs for patients with kidney problems.
It is often combined with other pain relievers and anti-inflammatory agents, especially codeine and ibuprofen.
Acetominophen carries side effects only with long term use or overdose - with kidney, liver and stomach damage being possible.
Even though it is the safest of the pain medications, acetominophen usually doesn't provide enough pain relief for sciatica sufferers.
Produced by the opium poppy, both opiates and opioids are used to lessen chronic and severe sciatic pain.[1,5,6,11]
- Opiates - codeine and morphine
- Opioids - oxycodone, hydrocodone, oxymorphone
These narcotics work by decreasing how pain is perceived in the brain, at the same time as increasing the body's pain tolerance. However they do not reduce inflammation.
Codeine is often combined with other medications, such as acetominophen, aspirin or ibuprofen.
This medication can be addicting, as it can produce a feeling of euphoria. and is therefore restricted in many countries. They may not be available over the counter, or without a prescription.
Warning: morphine should be avoided if you have kidney problems.
There are a large number of risks and common side effects:
- These medications often cause nausea and vomiting, and constipation.
- With long term use, the immune system is compromised, leaving you more vulnerable to bacteria and virus infections.
- Itchy skin is oft reported, as is drowsiness, headaches and depression.
- The high (euphoria) is addictive, and it is easy for your body to become tolerant - needing a higher dosage to treat the same pain. The withdrawal effects after long term or heavy use are severe.
Sleepless for days
I took tramadol once for less than one week. Although it masked all pain, it also stopped me from sleeping.
After 72 hours without sleep, with its associated dizziness, nausea and anxiety, the doctors advised me to stop taking it.
Originally developed as an alternative to opioids, tramadol can fight pain without the severe stomach and gastric problems that NSAIDs cause. Still many patients report some similar side effects.
Often prescribed to treat arthritis pain and fibromyalgia, tramadol blocks sciatic pain in a way similar to an opioid, but without depressing the immune system.
Restricted in many countries, tramadol may not be available over the counter or without a prescription.
There are a number of side effects commonly seen when taking tramadol:
- Nausea, vomiting and constipation are possible.
- Skin can become extremely itchy.
- Seizures are possible, especially in susceptible people.
- It does cause drowsiness.
- The body becomes dependent (but not addicted or tolerant), and severe withdrawal symptoms are possible if the medication is stopped abruptly.
Tricyclic antidepressants, such as amitriptyline or nortriptyline, were initially shown to have a positive effect on chronic pain in patients who are not depressed, especially with long term neuropathic (nerve) pain, even though they have many negative side effects.[1,7]
Personally, I had no improvement in any pain (sciatic, fibromyalgia, and other illnesses) when taking any of 4 different types of anti-depressants.
More recent studies have questioned the effectiveness, especially when the number of negative side effects are taken into account.
- Nausea, vomiting and constipation are very common.
- There may be difficulty urinating, putting strain on the kidneys.
- Drowsiness, confusion, anxiety and memory/thinking problems are also fairly common.
- Some patients experience dizziness and blurred vision.
- There are usually withdrawal symptoms if the medication is stopped abruptly.
Cyclobenzaprine, diazepam, carisoprodol and methocarbamol may be prescribed to relieve pain and relax muscles when no cause for sciatic pain can be found, even though studies have been inconclusive.[1,5,12]
The side effects of drowsiness and addiction outweigh the slight pain-relieving benefits received. There is also the risk of becoming addicted to the relaxed feeling provided, dependent on medication to sleep, plus these medications so lose effectiveness with longer term use.
Warning: Muscle relaxants should be avoided by people with liver and kidney disorders, as well as by those who suffer depression.
- Nausea and vomiting are common side effects.
- Some patients have reported severe itching.
- These commonly cause dizziness, headaches, fever, poor coordination and balance problems.
- Drowsiness and depression are also common.
- Muscle relaxants are addictive, with users seeking the euphoric feeling (high). Patients become dependent on them for sleep, and increasingly higher doses are required with longer term use (tolerance). There are withdrawal effects if the medication is stopped abruptly.
Gabapentin - anticonvulsant
Originally an anti-epiliptic medication, gabapentin, taken in low doses, is being trialled in chronic pain patients especially in neuropathic (nerve) pain, fibromyalgia and as a short term treatment for sciatica.[1,7,13]
Pregabalin, another anti-convulsant, may also be given for sciatic pain.
Gabapentin and pregabalin work by blocking or reducing the pain messages received in the brain.
Personally, I have taken gabapentin for about 10 years, at a reasonably low dose, to manage fibromyalgia pain. It does help with the background pain, but not usually with sharp, spiking, sciatic pain.
There are a number of side effects of taking gabapentin and pregabalin.
- Fluid retention and skin swelling is common.
- Drowsiness and mood disorders are also fairly common.
- Patients often report dizziness and loss of co-ordination (me!)
- Weight gain is a problem with long term use.
- The body does become dependent on gabapentin - you do notice if you miss a regular dose. There are quite painful withdrawal symptoms if you stop the medication abruptly.
Corticosteroid epidural injections
Corticosteroids with a small amount of anesthetic, may be injected close to the compressed and irritated sciatic nerve to reduce inflammation.
Prednisolone, methylprednisolone or dexamethosone may be prescribed as injections to treat acute and severe sciatic cases, or when spondyloarthritis is heavily localized in one or two spinal 'joints'.
Epidurals are normally only considered in extreme cases of sciatica caused by spinal damage. They provide short term pain relief, and only recommended for 1-2 months of treatment.[7,14]
There are a number of risks and side effects of such injections.
- Low blood pressure and dizziness can result.
- Drowsiness, depression and blurred vision can occur for a short period after the injection.
- Muscles around the injection site can become weak, numb and lose function.
- It is also relatively common for there to be no pain relief at all!
Know your medications and their scientific namesview quiz statistics
- Medications for acute and chronic low back pain: a review of the evidence for an APS / ACP clinical practice guideline, R. Chou, et.al., Annals of Internal Medicine, 2007, 147(7):505-514
- Guideline update: what's the best approach to acute low back pain? S.M. Bach and K.B. Holten, Journal of family practice, December 2009, 58(12):E1
- Lack of Effectiveness of Bed Rest for Sciatica, C.A.J. Patrick, et.al., New England Journal of Medicine, 1999, 340:418- 423
- Piriformis syndrome: implications of anatomical variations, diagnostic techniques, and treatment options, L. Cassidy, et.al., Surgical and Radiologic Anatomy, February 2012 (PubMed ahead of publication)
- Medication use for low back pain in primary care, D.C. Cherkin, et.al., Spine, March 1998, 23(5):607-14
- Patients' own accounts of sciatica: a qualitative study, B.N. Ong, et.al., Spine, July 2011, 36(15):1251-6
- Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis, R.Z. Pinto, et.al., BMJ (Clinical Research), February 2012, 344:e497
- Nonsteroidal anti-inflammatory drugs for low back pain: an updated Cochrane review, P.D. Roelofs, et.al., Spine, July 2008, 33(16):1766-74
- Anti-inflammatory effects of the willow bark extract STW 33-I (Proaktiv(®)) in LPS-activated human monocytes and differentiated macrophages, G.A. Bonaterra, et.al., Journal of Phytomedicine, December 2010, 17(14):1106-13
- An updated overview of clinical guidelines for the management of non-specific low back pain in primary care, B.W. Koes, et.al., European Spine Journal, December 2010, 19(12): 2075–2094
- Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction, B.A. Martell, et.al., Cochrane Database of Systematic Reviews, 2008, (1):CD001703
- Is there a role for benzodiazepines in the management of lumbar disc prolapse with acute sciatica? Brötz D, et.al., Pain, June 2010, 149(3):470-5
- Anticonvulsant drugs for acute and chronic pain, P. Wiffen, et.al., Cochrane database of systematic reviews, 2005, (3):CD001133
- Comparison of Epidural Steroid Injections with conservative management in patients with lumbar radiculopathy, N. Laiq, et.al., Journal of the College of Physicians and Surgeons - Pakistan, September 2009, 19(9):539-43
- Does therapeutic use of acetominophen cause acute liver failure? A.C. Dart, et.al., Pharmacotherapy, September 2007, 9:1219-30
The most important thing is to find the underlying cause of the sciatic pain.
Only then you can choose a medication and treatment plan that will address the cause, and not mask the symptoms.
Which medications have helped your sciatica? What side effects did you experience from these medications? Let us know in the comments below!