Prescription Medications: Sciatica

Prescription Medications: Sciatica is a term used to describe neuropathic/nerve pain. It is a prevalent condition known as a lumbosacral radicular syndrome. It’s discomforting, numbness, and tingling, combined with sharp shooting pain that can present anywhere from the low back where the nerve begins and down the leg into the foot. The most common cause is a bulging or herniated disc. The first medical recommendations are:

• Ice and Heat packs
• Physical therapy
• Chiropractic
• Over-the-counter pain relievers:
• Acetaminophen – Tylenol
• Non-steroidal anti-inflammatory drugs – NSAIDs:
• Naproxen – Aleve
• Ibuprofen – Advil, Motrin

However, when that is not enough, the next step usually involves prescription medications to treat the nerve pain.

Prescription Medications

The following are a few prescription medications for sciatica:

• Prescription-only NSAID diclofenac
• Gabapentin
• Topiramate

When it comes to prescription medications for non-specific lower back pain, medical guidelines are in agreement. Here’s a look at what the research shows about their effectiveness.

Diclofenac

Inflammation is a normal response of the immune system. However, the inflammation can irritate the nerves of the spinal column to the rest of the body, causing swelling and sciatica symptoms. NSAIDs are available as over-the-counter and prescription meds and can reduce inflammation, bringing relief from nerve pain, including sciatica.

Dosage

Diclofenac is taken by mouth with its total daily dose or TDD and can range from 75 to 200 mg.

Side Effects

Possible short-term side effects of NSAIDs can include:

• Upset stomach
• Heartburn
• Nausea
• Headache
• Dizziness

Gabapentin

Gabapentin is commonly used to treat diabetic neuropathy and chronic sciatica nerve pain. However, it can take some time, possibly more than two weeks, to activate, and its effectiveness relieves sciatic nerve pain for up to 3 months. It works by calming down nerve cells to relieve neuropathic/nerve pain. It calms down the nerves by lowering the amounts of chemicals in the nervous system. An overabundance of chemicals can excite the nerve cells to the point of inflammation. Substance P is a neurotransmitter and a neuromodulator that plays a role in how the body perceives pain. Gabapentin helps to lower substance P levels.

Dosage

It is taken by mouth with its TDD typically between 900 to 3,600 mg, divided into multiple daily doses.

Side Effects

Common side effects include:

• Drowsiness/sleepiness
• Dizziness
• Arms and/or Leg swelling
• Diarrhea
• Weakness

Topiramate

Like the other anti-seizure medications, topiramate is thought to relieve nerve pain by calming down the nerve cells by attaching to the glutamate receptor and preventing it from activating pain signals. Topiramate is commonly used to alleviate sciatica symptoms but may not be as effective after three months and does not lower disability from the low back and sciatic pain.

Dosage

The TDD for topiramate ranges between 50 to 400 mg.

Side Effects

Side effects can include:

• Drowsiness/sleepiness
• Sleep problems
• Mood/behavioral changes
• Trouble with memory
• Nervousness
• Appetite loss
• Weight loss
• Dizziness
• Numbness or tingling sensations

Non-Pharmacological Sciatic Decompression

Decompression Diagnostics Specialists

References

Baron, R., et al. (2010). The efficacy and safety of pregabalin in the treatment of neuropathic pain associated with chronic lumbosacral radiculopathy. Pain.

Dydyk AM, Conermann T. Chronic Pain. [Updated 2021 Nov 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK553030/

Oliver Enke, Heather A. New, Charles H. New, Stephanie Mathieson, Andrew J. McLachlan, Jane Latimer, Christopher G. Maher, C.-W. Christine Lin. Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis. CMAJ Jul 2018, 190 (26) E786-E793; DOI: 10.1503/cmaj.171333

Rasmussen-Barr, Eva, et al. “Non-steroidal anti-inflammatory drugs for sciatica.” The Cochrane database of systematic reviews vol. 10,10 CD012382. 15 Oct. 2016, doi:10.1002/14651858.CD012382