Sciatica. Management for family physicians

Abstract

Sciatica or lower back pain with sciatic radiation is a frequent medical problem in primary care. The aim of this article is to better inform medical practitioners on diagnosis and management of lower back pain with sciatic radiation. Updated information on sciatica management is important for family physicians. Here, we review the available literature on sciatica. Relevant articles were identified via a literature search in PubMed by focusing on the following key points: diagnostic and definition criteria, red flags, and therapy. In addition, the authors' clinical experience has been utilised to propose a schema to assist in the assessment and treatment of sciatica in a primary care setting. Sciatica diagnosis is based on a careful history and clinical examination. Imaging is usually not necessary at first; testing with X-ray and MRI are key to diagnosing lumbar instability and herniated discs. Management includes physical conditioning, proper pain management, and surgery as a last resort. Pain treatment includes analgesics, anticonvulsants and muscle relaxants. A more aggressive approach would include epidural infiltrations and radiofrequency.

Keywords

• herniated disc
• lower back pain
• neurosurgery
• physical therapy