In most cases, sciatica flare-ups are minor events that can be relieved without seeking medical attention. During a flare-up, patients should try to avoid activities that trigger sciatica pain. Rest can be helpful, but too much inactivity may worsen symptoms.

Other measures that may help reduce symptoms include:

• Cold packs (cryotherapy). Ice can be applied to painful areas for 15 to 20 minutes several times daily. Patients are advised to wrap ice in a towel or use a cold pack – ice should not be applied directly to the skin. At least 15 minutes should separate sessions of therapy with ice.
  
  
• Heat treatment (thermotherapy). Forty-eight hours after cold packs are first applied, patients can apply heat to areas that are causing pain. Methods of thermotherapy include warm packs, heat lamps or heating pads kept on the lowest setting. Patients who continue to experience pain are advised to alternate cold and warm therapy.
  
  
• Stretching. Passive stretching can help relieve compression. It is important not to jerk, bounce or twist during stretching.
  
  
• Over-the-counter pain medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen or naproxen can help relieve inflammation and pain. Analgesic medications such as acetaminophen relieve pain but do not reduce inflammation.
  
  
• Regular exercise. An active lifestyle is one of the best ways to combat chronic discomfort. During exercise, the body releases chemicals called endorphins that prevent pain signals from reaching the brain. These chemicals also help relieve depression and anxiety. People who add strength training and stretching to their exercise regimen can help slow age-related degenerative changes to the back. Patients should consult a physician before beginning an exercise regimen.

In some cases, sciatica may become severe enough to warrant medical attention. In such situations, treatments recommended by physicians may include:

• Prescription drugs. Prescription anti-inflammatories can provide relief at dosage levels that are higher than those found in over-the-counter medication. In addition, other medications that may help relieve pain brought on by sciatica include:
  
• • Anticonvulsants. Drugs primarily used to treat seizures. They also may be effective in treating certain types of nerve pain. Anticonvulsants are often prescribed with analgesics.
    
    
  • Antidepressants. Some antidepressants, particularly tricyclic antidepressants, can relieve pain and assist with sleep.
    
    
• Rehabilitation. Patients with a herniated disc may be advised to work with a physical therapist on a rehabilitation program that can help prevent recurrence of injury. Physical therapy can help patients correct their posture, strengthen the muscles of their backs and improve flexibility. In addition, a physician may prescribe occupational therapy so the patient can learn how to safely perform daily activities such as bathing and cooking, sometimes with the use of assistive devices such as shower benches.

• Acupuncture or acupressure.
  
  
• Injection therapy, such as:
  
• • Epidural corticosteroid injections. When other treatments fail, a physician may suggest treating sciatica pain with an injection of corticosteroid medication, which mimics the effects of the natural hormones cortisone and hydrocortisone in suppressing inflammation. However, these drugs must be used in limited doses under a physician's close supervision, as they can have substantial side effects.
    
    
  • Nerve blocks. Sciatic nerve roots can be injected with corticosteroids. These injections also work by decreasing inflammation around the nerve causing pain relief.
    
    Injection therapy should be performed by a trained pain management physician.
    
    
• Surgery. Spine surgery may be an option for patients who fail to respond to other treatments, or who have significant weakness or pain that keeps worsening. In most cases, surgery consists of removing part of a herniated disc (discectomy) that is pressing on a nerve and causing sciatic pain. A laminectomy may be another option. In many cases, surgery will provide short–term relief but cannot prevent degenerative changes that may cause pain to return over time.
  
  
• Spinal cord stimulation. This is a relatively new technology for sciatica patients who have failed conservative measures including nerve blocks and sometimes have also failed surgery.