Sciatic Nerve Pain: 6 Prescription Medications That May Help

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Sciatica is a very common condition that's also known as lumbosacral radiculopathy. Up to 40% of people will have sciatica within their lifetime. People with sciatica experience pain that travels from the low back down to the leg (along the length of the sciatic nerve).

A common medication class used for sciatica is non-opioid pain relievers, such as diclofenac (Cataflam). Corticosteroids, such as prednisone, may also be prescribed. Several other types of medications may sometimes be used. But as we'll discuss throughout this article, there's very little clinical evidence to support the use of most medications for sciatic nerve pain.

What is sciatica?

People with sciatica experience pain that radiates from the low back down to their leg, sometimes with a tingling sensation. The most common cause of sciatic nerve pain is a bulging or herniated disc.

In general, the first treatments to try are heat or ice packs, gentle stretching, and over-the-counter (OTC) pain relievers. These pain medications include acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen (Aleve) and ibuprofen (Advil, Motrin). But when that's not enough, where should you turn for relief?

For sciatica, the next step usually involves prescription medications.

Prescription sciatica medications

The following are some medications that may be prescribed for sciatica:

• Prescription-only NSAIDs, such as diclofenac

• Corticosteroids ("steroids"), such as prednisone

• Gabapentin (Neurontin)

• Pregabalin (Lyrica)

• Amitriptyline

• Opioid pain medications

When it comes to prescription medications for non-specific low back pain, treatment guidelines are typically consistent. A universal agreement for dealing with sciatic nerve pain prescription medications, however, is lacking. But there are some medications that are commonly used for sciatica.

It's important to note that these medications aren't FDA-approved to treat sciatica. That's because, as we'll discuss, the evidence supporting their use is conflicting and limited. Sciatica treatment with these medications is considered an off-label use for the medications discussed here.

So what is the best medicine for sciatica pain? Here's a look at six medications and what the research shows about their effectiveness against sciatic nerve pain.

1. Diclofenac

NSAIDs are available as OTC and prescription products. Prescription NSAIDs (like diclofenac) are typically used to relieve mild to moderate pain, which could include pain from sciatica.

Clinical studies suggest that people with sciatica might experience some pain relief from NSAIDs, like diclofenac. In fact, NSAIDs had better global improvement results than placebo (a substance with no medication in it). Global improvement is the percentage of people with sciatica who expressed an improvement in their condition. But many of these study participants had acute (short-term) sciatica, which didn't last more than 3 weeks. So, more long-term studies are needed to see if prescription NSAIDs would also be helpful for chronic (long-term) sciatica.

How does diclofenac work to relieve sciatic nerve pain?

Inflammation (swelling) might be the cause of sciatica symptoms in some people. Inflammation is a common response of the immune system. This can irritate the nerves that stem from the spinal column of your back and stretch out to the rest of your body.

NSAIDs - like diclofenac - can reduce this inflammation, which may relieve sciatic nerve pain.

Diclofenac dosage for sciatic nerve pain

When taking diclofenac for sciatica, it's taken by mouth. In studies, its total daily dose ranged from 75 mg to 200 mg.

Common side effects of diclofenac

Possible short-term side effects of diclofenac and other NSAIDs may include:

• Dizziness

• Headache

• Heartburn

• Nausea

• Stomach upset

2. Prednisone

Prednisone is a steroid prescribed for many medical conditions to relieve inflammation. This could include inflammation due to sciatica. Most clinical studies on corticosteroids and sciatica didn't find this group of medications to work any better for pain than placebo. However, a small 2016 clinical trial found that short-term prednisone moderately improved people's function and mobility, even though it didn't relieve their pain.

How does prednisone work to relieve sciatic nerve pain?

As discussed, sciatica symptoms are thought to result from irritation or compression of your nerves that leave the spinal column. Steroids - like prednisone - may help with sciatica by decreasing inflammation.

Prednisone dosage for sciatic nerve pain

For sciatica treatment, study participants from the 2016 clinical trial took doses of oral prednisone for a total of 15 days. Your prescriber may choose to use a different dose schedule. But short-term courses of steroids are preferred to lower the risk of serious and long-term side effects.

Common side effects of prednisone

Common side effects of short-term prednisone use may include:

• Larger appetite

• Indigestion

• Nervousness

• Sleeping difficulties

• Fluid retention

• Sweating

• Mood changes

3. Gabapentin (Neurontin)

Gabapentin (Neurontin) is commonly used to treat nerve pain caused by diabetes (diabetic neuropathy). It's also been studied for treatment of chronic sciatica. Early evidence suggested that gabapentin was more effective at reducing sciatic nerve pain when compared with placebo. But further evidence shows it's not as helpful as initially thought. So it's less prescribed for sciatica now than it was in the past.

Currently, using gabapentin for sciatica is not recommended because its risk of side effects outweigh potential benefits.

How does gabapentin work to relieve sciatic nerve pain?

In general, gabapentin calms down neurons (nerve cells) to relieve nerve pain. It does this by lowering the amounts of excitatory chemicals, like norepinephrine and glutamate, in the nervous system. Too much of these chemicals can make the nerve cells overexcited. Gabapentin also lowers substance P levels. Substance P plays a role in how you perceive pain.

Gabapentin dosage for sciatica nerve pain

Gabapentin dosages for sciatica nerve pain typically start at 300 mg to 900 mg by mouth 3 times a day. This dosage is slowly increased by your prescriber depending on your response to the medication.

Common side effects of gabapentin

Common side effects of gabapentin may include:

• Dizziness

• Drowsiness or sleepiness

• Swelling of the arms or legs

• Nausea

• Weakness

• Diarrhea

• Weight gain

4. Pregabalin (Lyrica)

While pregabalin (Lyrica) has been shown to help diabetic neuropathy, a small 2017 study on sciatica was discouraging. It showed that taking pregabalin for 8 weeks did not relieve sciatic pain better than a placebo.

So far, there is no strong evidence that pregabalin is helpful when it comes to treating sciatic nerve pain.

How does pregabalin work to relieve sciatic nerve pain?

Pregabalin works similarly to gabapentin. Like gabapentin, pregabalin is also thought to relieve nerve pain by lowering levels of substance P and excitatory chemicals in the nervous system.

Pregabalin dosage for sciatica nerve pain

In studies, participants took a range of pregabalin dosages for sciatica. Overall, people started with a dosage of 75 mg twice a day. Your prescriber may raise your dose slowly, depending on how you respond to it.

Common side effects of pregabalin

Pregabalin's common side effects may include:

• Constipation

• Dizziness

• Coordination problems

• Drowsiness or sleepiness

• Dry mouth

• Swelling in the arms and legs

• Trouble focusing

• Memory issues

• Weight gain

5. Amitriptyline

Amitriptyline is a tricyclic antidepressant (TCA). But it also has many uses other than depression, including migraine prevention and relief of shingles-related nerve pain. Some healthcare professionals also prescribe it for sciatica.

A clinical trial compared amitriptyline to placebo for sciatica over 9 months. All study participants were also receiving corticosteroid injections. Researchers found that amitriptyline helped relieve sciatic nerve pain more than placebo. So amitriptyline may be helpful for some people with sciatica.

How does amitriptyline work to relieve sciatic nerve pain?

In general, TCAs, like amitriptyline, relieve nerve pain by raising the amounts of two chemicals in the nervous system: serotonin and norepinephrine. In doing so, TCAs encourage pathways in the central nervous system (CNS) - or the brain and spinal cord - to block pain signals. TCAs also have effects on several other receptors (chemical binding sites) in the body that may help relieve pain.

Amitriptyline dosage for sciatica nerve pain

In studies, amitriptyline total daily doses for sciatica nerve pain ranged between 10 mg to 50 mg.

Common side effects of amitriptyline

Some possible side effects of amitriptyline may include:

• Abnormal heart rhythm

• Constipation

• Drowsiness or sleepiness

• Dry mouth

• Urinating (peeing) difficulties

6. Opioid pain relievers

Sciatica pain can be intense for some people. In certain cases, healthcare professionals may prescribe medication that can relieve severe pain, such as opioids. But results from a small 2007 study showed that morphine (a type of opioid pain reliever) isn't effective at relieving back and leg pain from sciatica.

Some expert organizations consider opioids as last-choice treatment options for the short-term relief of nerve pain. This means they would only be tried if no other sciatica medications have helped relieve your pain and it's greatly interfering with your daily life. Other expert organizations recommend avoiding opioids for sciatica altogether. This is due to their lack of effectiveness and risk of serious side effects.

How do opioids work to relieve sciatica nerve pain?

In general, opioids are thought to work by influencing how the CNS responds to pain. But opioids aren't always a good option for relieving nerve pain.

Opioid dosage for sciatic nerve pain

Dosing for opioids varies greatly depending on the medication being prescribed. In general, a prescriber would start with the lowest effective dosage. This helps to limit side effects. It also helps lower the risk of dependence and addiction, which are possible with all opioid medications.

Common side effects of opioids

Some common side effects of opioids include:

• Constipation

• Dizziness

• Drowsiness or sleepiness

• Nausea

• Vomiting

• Itching

Gabapentin (Neurontin) vs. pregabalin (Lyrica)

While gabapentin and pregabalin are typical go-to medications for nerve pain conditions, they do have some differences:

• Pregabalin is better absorbed into the bloodstream than gabapentin.

• Food raises gabapentin's absorption into the bloodstream.

• Food doesn't significantly impact pregabalin's absorption into the bloodstream.

But what about when it comes to sciatica? Although the above points make pregabalin a preferred choice for some types of nerve pain, this isn't the case with sciatica. A small study comparing gabapentin to pregabalin for chronic sciatica found that gabapentin might be the better option. The study showed that treatment with gabapentin resulted in more pain relief and had less risk of side effects when compared to pregabalin.

But keep in mind that neither gabapentin nor pregabalin are recommended as first-choice sciatica medications.

Combining medications to help with sciatic nerve pain

Less than 50% of people with nerve pain will get enough relief from one medication. So, combining medications might be necessary to help with sciatic nerve pain. Guidelines for sciatica, however, are inconsistent. But in general, oral combination therapy for nerve pain may include a combination of the following:

• Gabapentanoids - like gabapentin or pregabalin

• Antidepressants - like amitriptyline

• Topical products - like capsaicin or lidocaine

Combining sciatica medications might further help relieve nerve pain, but there is also a higher risk of side effects. Let's discuss an example combination therapy for sciatica.

Amitriptyline and gabapentin for sciatica

In one small 2016 trial, patients who were taking amitriptyline added gabapentin to their regimen. More than half of the people in the study noted an improvement in pain relief when gabapentin was added.

However, side effects from gabapentin were common. More than a third of the people in the study stopped taking gabapentin due to side effects. People who had side effects also didn't experience as much improvement in their sciatica symptoms.

Best cream for sciatica

Again, recommendations for sciatica are conflicting. In fact, topical products weren't mentioned in a thorough review of many sciatica-related guidelines. This is because there isn't much clinical evidence to support their use for this type of pain.

But in general, capsaicin and lidocaine are considered first-choice topical medications for other types of nerve pain. These creams can be used by themselves or with other sciatica medications, such as gabapentin, pregabalin, or amitriptyline.

Capsaicin

Capsaicin relieves nerve pain by attaching to the TRPV1 receptor, which is located on certain nerve cells and helps send pain signals to our brain. Long-term use of capsaicin causes these nerve cells to become overexcited and release all of their substance P until there is nothing left. This stops them from being able to send pain signals to the brain. Eventually, these nerve cells will become less sensitive to pain.

Capsaicin may cause the following side effects at the application site (place where the product is applied):

• Burning sensation

• Irritation

• Itchiness

• Redness

Lidocaine

Lidocaine relieves nerve pain by blocking your nerve cells from sending pain signals.

Common side effects of lidocaine at the application site may include:

• Itchiness

• Pale skin with red spots

• Swelling

• Tingling sensation

Frequently asked questions

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