Sciatica, sometimes referred to as lumbar radicular pain, is pain due to irritation of the sciatic nerve. The sciatic nerves are a pair of large nerves that begin in the lower (lumbar) spine from a group of spinal nerve roots, and that pass through the hips and buttocks and down each leg. Sciatica may be due to compression and/or inflammation of the nerve roots. Common underlying causes include a herniated disc (also known as a slipped or bulging disc), narrowing of the spinal canal (spinal stenosis), degenerative disc disease, and spinal trauma or injury.

Symptoms:

• Pain radiating from the lower back and/or buttock down the back of the leg
• Leg pain worse than low back pain
• Pain described as aching, burning, or shooting
• Pins-and-needles and/or numbness in the lower leg
• Weakness in the leg or foot
• Increased pain when sitting, coughing, sneezing, or straining

Diagnosis:

There is no specific diagnostic test for sciatica. Diagnosis involves reviewing a patient’s symptoms and medical history and performing a physical examination. Diagnosis will include an evaluation of:

• Onset, type, location, and duration of pain and symptoms
• Associated symptoms, such as pins-and-needles, numbness, and/or weakness in the legs
• History of back and leg pain
• Presence of risk factors, such as age-related disc degeneration, spinal stenosis, obesity, smoking, manual labour, and diabetes.
• Excluding serious pathology such as spinal trauma, infection, and cancer
• Physical examination findings.

During physical examination, the doctor may test for possible lumbar disc herniation by conducting a “straight leg raise test”, testing for motor weakness by assessing knee and ankle reflexes, and testing for sensory loss by performing light touch and pin prick tests. Imaging is not usually performed unless symptoms persist for more than 12 weeks or worsen despite conservative treatment, or if serious underlying pathology is suspected. Imaging may include magnetic resonance imaging (MRI) or discogram (to look for disc abnormalities).

Treatment:

In most cases, the pain resolves within 6 to 12 weeks with conservative treatment. Initial treatment aims to reduce the pain and maintain physical functioning. Conservative treatment options include:

• Exercise and Physical Therapy: It is important to avoid bed rest and return to physical activity as soon as possible to reduce recovery time and to reduce the risk of pain and symptoms persisting or becoming worse. Staying active will help keep your spine and muscles healthy and reduce the impact that sciatica has on daily life. In addition, exercise may help reduce the pain and symptoms of sciatica. Your pain specialist can refer you to a physiotherapist or exercise physiologist who may prescribe appropriate exercises based on the severity of your pain and physical ability. A home-based, supervised, or group-based exercise program may be recommended. Some forms of manual therapy, such as spinal mobilisation, may be performed in combination with exercise therapy.

• Medications: Over-the-counter pain medications such as paracetamol and non-steroidal anti-inflammatory drugs such as ibuprofen may provide initial pain relief and help keep you active. Oral steroids may also improve symptoms in the first 6 weeks. Weak opioids may be prescribed sparingly for severe pain but only in the short-term. Patients should be aware of the potential side effects of such medications, especially opioids, which can cause dependence. It is generally advised that medications only be used for a short period of time at a low dose. Your pain physician will discuss appropriate medications for sciatica.

• Spinal Injections: Lumbar spine injections may help with severe, acute sciatic pain, especially when the pain is preventing you from engaging in exercise and physical therapy. This typically involves an epidural injection of local anaesthetic and steroid into the area of the affected lumbar nerve roots. The aim is to reduce inflammation and pain, especially in the case of a herniated or degenerated disc, and to improve mobility and function of the legs. The results are usually short-term, though some people report long-lasting benefits. Repeat injections may be performed.

• Lifestyle Factors: Looking after your general health can help to prevent sciatica and worsening of symptoms. Besides staying active, managing risk factors by maintaining a healthy weight, quitting smoking, and eating a balanced diet with enough vitamin B12 may assist with recovery from sciatica. If pain and symptoms persist for more than 12 weeks despite conservative treatment or if serious underlying pathology is confirmed with imaging, surgery may be an option. Your pain physician will discuss surgical options with you if appropriate. The two most common surgeries performed for sciatica are:

• Microdiscectomy: For those with lumbar disc herniation, microdiscectomy may be performed. It involves removing a small portion of disc and can be performed using minimally invasive techniques, such as endoscopic surgery.

• Laminectomy: For those with nerve root compression, decompression surgery such as laminectomy may be performed. This is most often performed for those with spinal stenosis. It involves removing part of the vertebra known as the lamina to create space for the spinal nerves. It is important to note that sciatica affects people in different ways and one person’s response to treatment will be different from another person’s. Your pain specialist will work out a plan on how best to treat you and your symptoms.

**This information sheet has been written for patients affected by sciatica and provides general information only**

References: Australian Family Physician (2004; 33: 409-412, “Lumbar radicular pain”); Better Health Channel (Victoria Health); Healthdirect.gov.au; Spine-Health; The BMJ (2019; 367: 16273, “Diagnosis and treatment of sciatica”).