Sciatica is the sensation of pain, tingling, or burning running along the course of the sciatic nerve. This is a big nerve that emerges from the spine, in the lower part of the back, and extends across each buttock to the back of the thigh, the outside edge of the lower leg and to the foot. You have two sciatic nerves, one coming out from each side of the spine.
Sciatic pain occurs due to compression or inflammation of the sciatic nerve. This may be in response to a sporting or lifting injury to the lower back, prolonged sitting, or sometimes it's caused by a slipped disc.
The specific location of the pain or altered sensation is dependent on where the nerve is irritated or compressed. Sciatica often resolves on its own, and pain can vary, but it's usually worst in the first few days and this can be managed with non-drug treatments and painkillers. The best painkillers for your sciatica will often depend on the severity and intensity of the pain, as well as any other health conditions you have and preferences for types of treatment.
Taking things easy, and resting for the first few days can help to relieve pain brought on by an acute episode of sciatica. If sleeping is difficult, try some altered positions like having a pillow under your knees if you sleep on your back. Or if you are a side sleeper, try with a pillow between your legs, or under your hips.
After this initial period of rest, it's important for recovery to introduce gentle exercise, so try gentle movements with appropriate pain relief. This means going about your day-to-day activities as normal, as far as you're able.
Alternating between hot and cold compression of the affected area may also help to relieve discomfort, especially muscle spasms associated with sciatica. A licensed chiropractor or physiotherapist may be helpful, as they can provide manipulation to ease the area, and targeted exercises to aid recovery.
Painkillers are useful for treating pain and helping recover from sciatica. Paracetamol is usually a safe and sensible place to start when reaching for painkillers, with relatively few risks or side effects if taken as instructed. It’s well-tolerated and may be sufficient for mild-moderate pain.
Non-steroidal anti-inflammatory drugs (NSAIDs) are particularly useful at treating back pain and sciatica, as they are a class of medications that work on pain and dampen down inflammation. Examples include ibuprofen, naproxen and diclofenac.
Oral paracetamol and ibuprofen and topical ibuprofen and diclofenac are available to buy from any pharmacy, but stronger NSAIDs such as naproxen need a prescription. If after using paracetamol or ibuprofen individually, try using them in combination. This will allow you to cover periods where the painkillers may wear off or add the extra layer of pain relief as they work in different ways on the body.
If after trying a combination of paracetamol and NSAIDs, you are still experiencing pain, you can try using a mild opioid combination such as co-codamol or co-dydramol as a replacement for paracetamol, which can be bought over-the-counter in a pharmacy. This contains paracetamol and small amounts of codeine or dihydrocodeine. This is only for short-term use, therefore if symptoms are still experienced after treatment with opioid painkillers for a few days, then you should speak to your doctor.
Side effects of the opioid family of medications include constipation, drowsiness and feeling dizzy, sick or slightly “out of it”. Certain people seem more susceptible to this than others.
If you find this is still not cutting it, and you need stronger painkillers than co-codamol, you should see your doctor.
If this is your first episode of sciatica or severe lower back or buttock pain, it's worth booking an appointment with your doctor to confirm the diagnosis. Your doctor will examine you, check what you have tried already, and consider prescribing other medications which can help with the pain.
Sciatica usually resolves itself by 6 to 12 weeks, with the worst of the pain starting to improve over the first few weeks. If your pain is not improving after a few weeks despite care and exercise at home, if the pain is severe or getting worse, or if it is affecting your daily activities, you should see your doctor to discuss this.
Signs that suggest you should book an urgent appointment with your doctor are lack of control when peeing or pooing, numbness around the buttocks and back passage, numbness in your legs, weakness of your lower legs, fevers or other severe symptoms that feel out of proportion with the problem.
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