1. Primary Care Management of Sciatica
Manoj Krishna
Spinal Surgeon

2. Evaluation Rule out Cauda Equina Syndrome Any bladder function change?
Any Peri-anal altered sensation?
Bilateral Leg pain?
Check pulses, hips and abdomen
Is Neurology progressive ?( Urgent referral)
Could it be non-spinal ?

3. Analgesia( Pain can be severe)
Consider Morphine. MST 20mg BD and Oromorph 10mg 6hourly for breakthrough pain. Continue till acute pain eases( 2-4 weeks) and then switch to Tramadol or Codeine.
Paracetamol and Naproxen
Gabapentin or Pregabalin
Diazapam in small doses for muscle spasm

4. Physical Therapy Refer early to Physiotherapy/Osteopath/Chiropractor
Monitor progress
If not improving at 6 weeks consider a referral to a spinal surgeon for consideration for an epidural injection/nerve root block- gives almost instant relief of pain for 6-12 weeks

5. Indications for referral and surgery
Suspected Cauda Equina syndrome and progressive neurodeficit
Diagnosis uncertain
Pain not settling by 6-8 weeks
Pain severe, disabling and not responding to analgesia
Patient who needs to return to work quickly and cannot afford to wait