Heat/ice
For acute sciatica pain, heat and ice packs are quite often the first step to try for relief. Usually ice or heat is applied for approximately 20 minutes, and repeated every two hours. Most people use ice first, but some people find more relief with heat. The two may be alternated.

Medications
Over-the-counter or prescription medications may also be helpful in relieving sciatica pain. Non-steroidal anti- inflammatory drugs (NSAIDs) or oral steroids can be used to reduce the inflammation and pain.

Epidural steroid injections
If the pain is severe, an epidural injection can be performed to reduce the inflammation. An epidural is different from oral medications because it injects steroids directly to the painful area around the sciatic nerve to help decrease the inflammation that may be causing the pain. While the effects tend to be temporary (providing pain relief for as little as one week up to a year), an epidural can be very effective in providing relief from an acute episode of sciatic pain. Importantly, it can provide sufficient relief to allow a patient to progress with a conditioning program.

Conservative care specialists
Treatment with a physical therapist, osteopathic physician, chiropractor or physiatrist can be helpful both to alleviate the painful symptoms and to help prevent future recurrences of sciatica. These conservative care professionals can assist in providing pain relief and developing a program to condition the back.

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Surgical treatments
If the pain is severe and has not gotten better within six to twelve weeks, it is reasonable to consider spine surgery. Depending on the cause and the duration of the sciatic pain, one of two surgical procedures may be considered: a microdecompression (microdiscectomy) or an open decompression (lumbar laminectomy).

Microdiscectomy (microdecompression)
In cases where the pain is due to a disc herniation, a microdiscectomy may be considered after 4 to 6 weeks if the pain is not relieved by conservative means. Urgent surgery is only necessary if there is progressive weakness in the legs, or sudden loss of bowel or bladder control. A microdiscectomy is typically an elective procedure, and the decision to have surgery is based on the amount of pain and dysfunction the patient is experiencing, and the length of time that the pain persists. Approximately 90% to 95% of patients will experience relief from their pain after this type of surgery.

Lumbar laminectomy (open decompression)
If the sciatica is associated with spinal stenosis, surgery may be offered as an option if the patient’s ability to maintain a normal level of activity falls to an unacceptable level. Again, surgery is elective and need only be considered for those patients who have not gotten better after conservative treatments. After a lumbar laminectomy (open decompression), approximately 70% to 80% of patients experience relief from their pain.