Sciatica, Lumboischialgia: Drug Therapy

Therapeutic target

To relieve pain and thus increase range of motion

Analgesia (pain relief) according to WHO staging scheme:
- Non-opioid analgesic (paracetamol, first-line agent).
- Low-potency opioid analgesic (e.g., tramadol) + non-opioid analgesic.
- High-potency opioid analgesic (eg, morphine) + non-opioid analgesic.
If necessary, also antiphlogistics / drugs that inhibit inflammatory processes (ie, non-steroidal anti-inflammatory drugs, NSAID), eg, ibuprofen.
If necessary, also use of muscle relaxants / drugs that relax the muscles, local anesthetics (local anesthesia).
If necessary, also glucocorticoids in acute radiculopathy (irritation or damage to the nerve roots) due to a lumbar (“belonging to the lumbar spine”) disc hernia (herniated disc).
After the acute pain symptoms subside: physical therapy and remedial gymnastics or physiotherapy (compensation of individual deficits: eg, limited mobility; reduced muscle strength, etc.).
See also under “Other therapy“.

Further notes

Transdermal therapy with buprenorphine (opioids; BUP; highly potent) improves sleep quality and reduces sleep disturbance in patients with moderate to severe chronic low back pain
Use of oral steroids (50-100 mg prednisolone) for acute radiculopathy secondary to lumbar disc herniation improves function (after three weeks) but not pain.
The antiepileptic drug pregabalin, which is increasingly used to treat neuropathic pain, did not relieve sciatic pain in a placebo-controlled trial.
Red Hand Letter:Tolperisone (muscle relaxants) is approved only for the treatment of poststroke spasticity in adults. Outside of this approved indication, for example, there is a risk of hypersensitivity reactions (up to and including anaphylactic shock) with no proven benefit.

Suitable dietary supplements should contain the following vital substances:

In the presence of insomnia (sleep disturbances) due to lumboischialgia, see below Insomnia/Medicinal Therapy/Supplements.