Sciatic Nerve Pain: 8 Prescription Medications That May Help
- Sciatica is a type of neuropathic (nerve) pain. It’s a term used to describe pain that starts from the low back and goes down to your leg.
- Nerve pain can be difficult to treat. But there are some prescription medications that are commonly used to treat sciatic nerve pain.
- Some medications might be more helpful than others. A common medication for sciatica is gabapentin (Neurontin), which has some evidence for reducing sciatic nerve pain.
Sciatica is a very common condition that’s also known as lumbosacral radicular syndrome or pain. 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.
A common medication class used for sciatica includes anti-seizure medications — like Neurontin (gabapentin), Lyrica (pregabalin), and Topamax (topiramate). Other medication classes may include tricyclic antidepressants (TCAs) like amitriptyline, corticosteroids like prednisone, and muscle relaxants like tizanidine (Zanaflex).
However, there’s a lot of conflicting information on which medications work best to relieve pain. In this article, we’ll discuss some oral (by mouth) prescriptions and topical (applied to the skin) products used for sciatic nerve pain.
What is sciatica?
Sciatica is the term for pain that radiates from the low back down to your leg, sometimes with a tingling sensation. The most common cause of sciatic nerve pain is a bulging or herniated disc.
In general, the first places to start are heat packs, physical therapy, and over-the-counter (OTC) pain relievers, such as acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen (Aleve) and ibuprofen (Advil, Motrin). But when that’s not enough, what’s the next step?
For sciatica, the next step usually involves prescription medications.
Medications for sciatica
The following are some medications that may be prescribed for sciatica:
- Prescription-only NSAIDs, like diclofenac
When it comes to prescription medications for non-specific low back pain, guidelines are typically in agreement with each other. A universal agreement for sciatic nerve pain prescription medications, however, is lacking. But there are some medications that are commonly used for sciatica. Here’s a look at 8 medications and what the research shows about their effectiveness against sciatic nerve pain.
NSAIDs are available as OTC and prescription products. Prescription NSAIDs (e.g., diclofenac) are typically used to relieve mild to moderate pain, including 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 of 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 leave the spinal column from your back 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 used for acute sciatica, diclofenac is taken by mouth. In studies, its total daily dose (TDD) ranged from 75 to 200 mg.
Common side effects of diclofenac
Possible short-term side effects of NSAIDs, like diclofenac, may include:
- Stomach upset
Gabapentin is commonly used to treat nerve pain in diabetes (diabetic neuropathy), and has also been studied for treatment of chronic sciatica. There is some evidence that gabapentin is more effective at reducing sciatic nerve pain when compared with placebo. But it can take some time to kick in, and its effectiveness is only short-term. It may take more than 2 weeks to work. And it’s helpful at relieving sciatic nerve pain for only up to 3 months.
How does gabapentin work to relieve sciatic nerve pain
In general, gabapentin calms down neurons (nerve cells) to relieve neuropathic (nerve) pain. It calms down the neurons 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 sciatic nerve pain
For sciatic nerve pain, gabapentin is taken by mouth. Gabapentin’s TDD is typically between 900 to 3,600 mg, which is divided into multiple doses throughout the day.
Common side effects of gabapentin
When used for sciatica, common side effects of gabapentin may include:
- Drowsiness or sleepiness
- Swelling of the arms or legs
While pregabalin 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.
In a 2010 clinical trial, people with sciatica initially responded to pregabalin therapy, but that response faded over time and was no better than placebo. These study participants, however, had chronic sciatica pain that lasted for more than 6 months. If you have chronic sciatica that doesn’t go away, you may prefer to have a medication that continues to work over time.
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 is very similar in structure 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 sciatic nerve pain
For sciatic nerve pain, pregabalin is taken by mouth. The TDD for pregabalin usually ranges between 150 to 600 mg.
Common side effects of pregabalin
Pregabalin was associated with higher rates of side effects than placebo. When taken for sciatica, pregabalin’s side effects may include:
- Drowsiness or sleepiness
- Dry mouth
- Weight gain
Topiramate is a commonly used medication for sciatica. There’s some evidence to suggest that topiramate may relieve sciatica symptoms. But it may not be as effective after 3 months. It also didn’t lower disability from low back sciatic nerve pain. More research is needed.
How does topiramate work to relieve sciatic nerve pain
Similar to the other anti-seizure meds — like gabapentin and pregabalin — topiramate is thought to relieve nerve pain by calming down nerve cells. But it calms down nerve cells by attaching to the glutamate receptor (chemical binding site) and preventing it from working.
Topiramate dosage for sciatic nerve pain
When used for sciatic nerve pain, the TDD for topiramate ranges between 50 to 400 mg.
Common side effects of topiramate
Side effects of topiramate may include:
- Appetite loss
- Drowsiness or sleepiness
- Sleeping difficulties
- Trouble with memory
- Mood or behavioral changes
- Numbness or tingling sensation
- Weight loss
Amitriptyline is commonly used to treat depression. But it also has a number of other uses, including shingles-related nerve pain. You may also see it used for sciatica.
Clinical trials suggest that TCAs, like amitriptyline, start relieving sciatic nerve pain at 3 weeks and continue to be effective for up to 12 months. Study participants also began to notice less disability at 3 months, and they continued to experience this benefit for up to 12 months. But additional studies are still needed.
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 in the body, including opioid receptors, that help relieve pain.
Amitriptyline dosage for sciatic nerve pain
To relieve sciatic nerve pain, amitriptyline is taken by mouth with a TDD range of 10 to 50 mg.
Common side effects of amitriptyline
Some possible side effects with amitriptyline may include:
- Abnormal heart rhythm
- Drowsiness or sleepiness
- Dry mouth
- Urinating (peeing) difficulties
Prednisone is a corticosteroid used for many medical conditions to relieve inflammation, including sciatica. In fact, a small 2016 clinical trial suggests that short-term prednisone might moderately improve your function or mobility. But prednisone didn’t relieve sciatic nerve pain.
How does prednisone work to relieve sciatic nerve pain
As discussed, sciatica symptoms are thought to result from swelling of your nerves that leave the spinal column. Steroids — like prednisone — may relieve sciatic nerve pain by lowering the swelling of these nerves.
Prednisone dosage for sciatic nerve pain
For the treatment of sciatica, study participants from the 2016 clinical trial took doses of oral prednisone for a total of 15 days. The dosage was lowered over the 15-day period, as the below directions state. Healthcare providers may choose to use a different dose schedule.
- Days 1 through 5: Take 60 mg of prednisone by mouth every day.
- Days 6 through 10: Take 40 mg of prednisone by mouth every day.
- Days 11 through 15: Take 20 mg of prednisone by mouth every day.
Common side effects of prednisone
Common side effects of short-term prednisone use may include:
- Larger appetite
- Sleeping difficulties
Morphine can be used to relieve severe pain. But results from a small 2007 study showed that morphine isn’t effective at relieving back and leg pain from sciatica.
Currently, experts consider opioids as fifth-line treatment options for the short-term relief of nerve pain.
How does morphine work to relieve sciatic nerve pain
In general, morphine is thought to work by influencing how the CNS responds to pain. But opioids like morphine aren’t always a good option at relieving nerve pain.
Morphine dosage for sciatic nerve pain
In the 2007 clinical trial, study participants took 15 mg of sustained-release morphine daily. But morphine was ineffective at relieving sciatic nerve pain.
Common side effects of morphine
Some common side effects of morphine include:
- Drowsiness or sleepiness
Tizanidine is a muscle relaxant that might be used for multiple sclerosis (MS), which is a type of autoimmune disorder. In MS, your immune system attacks parts of your body — like your nerve cells — by mistake. In general, however, muscle relaxants aren’t better than placebo at relieving sciatica symptoms.
How does tizanidine work to relieve sciatic nerve pain
Tizanidine is an antispastic or a spasmolytic muscle relaxant. In general, this type of muscle relaxant is thought to work by relieving muscle spasms due to a brain injury or nerve damage. But these medications, including tizanidine, might be ineffective for sciatica.
Tizanidine dosage for sciatic nerve pain
The typical starting dose for tizanidine is 2 mg by mouth every 6 to 8 hours as needed. The maximum TDD for tizanidine is usually 36 mg.
Common side effects of tizanidine
Some common side effects of tizanidine may include:
- Dizziness or lightheadedness
- Dry mouth
- Urinary tract infections (UTIs)
Pregabalin (Lyrica) vs. Gabapentin (Neurontin)
While pregabalin and gabapentin 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 affect 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 pregabalin to gabapentin for chronic sciatic nerve pain 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.
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 will likely include a combination of the following:
- Gabapentanoids — like gabapentin or pregabalin
- Antidepressants — like amitriptyline
- Topical products — like lidocaine or capsaicin
Combining medications might further help relieve sciatic nerve pain, but there is also a higher risk of side effects. Let’s discuss an example combination therapy for sciatica next.
Neurontin (gabapentin) and Elavil (amitriptyline) for sciatica
In one small 2016 trial, patients who were using 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 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.
Some common side effects of combination therapy include:
- Confusion and memory problems
- Uncoordinated muscle movements
- Dry mouth
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.
But in general, capsaicin and lidocaine are considered first-choice topical medications for nerve pain. These creams can be used by themselves or with other go-to medications, such as gabapentin, pregabalin, or TCAs.
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
Capsaicin may also irritate your throat and cause sneezing or coughing.
Lidocaine relieves nerve pain by blocking your nerve cells from sending pain signals.
Common side effects of lidocaine at the application site may include:
- Pale skin with red spots
- Tingling sensation
The bottom line
Guidelines for sciatic nerve pain prescription medications are conflicting. There are several medications that are typically used for sciatica, but some might be more helpful than others.
Some studies suggest that gabapentin, amitriptyline, or topiramate might help people with sciatica. For some people, combining gabapentin and amitriptyline may relieve sciatic nerve pain further. But these medications are not without side effects.
If you have questions or concerns about medications for sciatica, reach out to your pharmacist or healthcare provider.
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Written by Ross Phan, PharmD, BCACP, BCGP, BCPS | Reviewed by Christina Aungst, PharmD