Sciatica: Leg Pain from a Compressed Nerve Root

Sources

1. MedlinePlus, US National Library of Medicine. Sciatica. Checked October 6, 2026.
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   Sciatica is “pain, weakness, numbness, or tingling in the leg” from injury to or pressure on the sciatic nerve, and “a symptom of a medical problem. It is not a medical condition by itself”; the nerve “starts in the lower back and runs down the back of each leg,” works the muscles of the back of the knee and lower leg, and carries sensation from the back of the thigh, the outer and back part of the lower leg and the sole of the foot; common causes include a herniated disk, spinal stenosis, piriformis syndrome (“a pain disorder involving the narrow muscle in the buttocks”), pelvic injury or fracture, tumors and spondylolisthesis; the pain may be a mild tingling, dull ache or burning, sometimes severe enough to stop a person moving, and “most often occurs on one side of the body”; it may reach the back of the calf or the sole of the foot, the leg may feel weak and the foot may catch on the ground; it may get worse after standing or sitting, at night, when sneezing, coughing or laughing (especially with a herniated disk), when bending backward or walking more than a few yards (especially with spinal stenosis), and when straining; the exam may show weakness, abnormal reflexes, numbness and pain when the straight leg is lifted; “Tests are often not needed unless pain is severe or long-lasting”; ibuprofen or acetaminophen over the counter; ice for the first 48 to 72 hours, then heat; “Bed rest is not recommended”; exercise again after 2 to 3 weeks, including core and spinal flexibility exercises; no heavy lifting or twisting for the first 6 weeks; injections to reduce swelling around the nerve if these measures do not help; for ongoing nerve pain, “a physiatrist (specialist in rehabilitation) or a pain specialist”; surgery is “usually the last resort”; “Often, sciatica gets better on its own. But it is common for it to return”; it “can lead to permanent numbness or weakness”; the symptoms that need a provider right away; prevention: avoid prolonged sitting or lying with pressure on the buttocks, and “Having strong back and abdominal muscles is important to avoid sciatica.” Reviewed August 27, 2024.
2. American Academy of Orthopaedic Surgeons, OrthoInfo. Sciatica. Checked October 6, 2026.
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   “Sciatica is a very broad term describing nerve pain, not a specific diagnosis”; the diagnosis is the cause of the nerve root compression, “such as a herniated disk” or spinal stenosis; pain from the lower back or hip that spreads to the back of the thigh and into the leg, like “a bad leg cramp,” sharp or electrical, worse when you move, sneeze or cough, with weakness, “pins and needles” numbness, burning or tingling; “You are most likely to get sciatica between the ages of 30 and 75”; under 40 the cause is typically a herniated disk, while older adults typically have bone spurs and arthritis; the history, the examination (squat and rise, heel and toe walking, the straight-leg raising test) and imaging to confirm which nerve roots are affected; “Approximately 80 to 90% of patients with sciatica get better over time without surgery, typically within several weeks if the underlying cause is a herniated disk”; with bone spurs and spinal stenosis nonsurgical treatment is less successful, with a good chance of improvement still; nonsurgical care aims to manage pain “without long-term use of medications”; NSAIDs such as ibuprofen, aspirin or naproxen, or muscle relaxants “may offer relief”; gentle heat or cold; “Do not remain in bed, as too much rest may cause other parts of the body to feel discomfort”; a cortisone-like injection; stretching as soon as possible, short walks and physical therapy; surgery “if you still have disabling leg pain after 3 or more months of nonsurgical treatment,” removing the disk or bone spurs pressing on the nerve; routine housework such as cooking and cleaning is fine while limiting too much bending or twisting; “it is always possible for your disk to rupture again.”
3. Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 2007;334(7607):1313–1317. doi:10.1136/bmj.39223.428495.BE (PMID 17585160).
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   “In about 90% of cases sciatica is caused by a herniated disc with nerve root compression, but lumbar stenoses and (less often) tumours are possible causes”; low back pain “is usually less severe than the leg pain”; the signs: one-sided leg pain greater than back pain, pain radiating to the foot or toes, numbness and pins and needles in the same area, more leg pain on straight leg raising, and nerve signs limited to one root; the straight leg raising test has a pooled sensitivity of 91% and specificity of 26%; “Imaging is indicated only in patients with ‘red flag’ conditions or in whom disc surgery is considered,” since disk herniations are found in 20% to 36% of people without symptoms; about 50% of people with acute sciatica in trial placebo groups improved within 10 days and about 75% after four weeks, while “a substantial proportion (up to 30%) continues to have pain for one year or longer”; a few hours of bed rest “does not result in faster recovery”; disk surgery “may provide quicker relief of leg pain than conservative care but no clear differences have been found after one or two years”; refer immediately for cauda equina syndrome or severe or progressive weakness “(within a few days).”
4. National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management (NG59). Last updated July 29, 2026. Checked October 6, 2026.
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   Acute means “Less than 3 months duration” and chronic “A 3-month duration or longer”; exclude specific causes “for example, cancer, infection, trauma or inflammatory disease” (1.1.1); “Do not routinely offer imaging in a non-specialist setting” (1.1.4), and in a musculoskeletal interface clinic or hospital only “if the result is likely to change management” (1.1.6); self-management advice with “encouragement to continue with normal activities” (1.2.1); consider a group exercise programme (1.2.2); do not offer belts or corsets, traction, acupuncture or TENS (1.2.3, 1.2.6, 1.2.8, 1.2.11); manual therapy “only as part of a treatment package that includes exercise” (1.2.7); “Promote and facilitate return to work or normal activities of daily living” (1.2.15); “Do not offer gabapentinoids, other antiepileptics, oral corticosteroids or benzodiazepines for managing sciatica as there is no overall evidence of benefit and there is evidence of harm” (1.2.16); “Do not offer opioids for managing chronic sciatica” (1.2.17); for people already taking opioids, gabapentinoids or benzodiazepines, explain the risks of continuing and discuss the problems of withdrawal (1.2.18–1.2.19); be aware of “the risk of harms and limited evidence of benefit” from NSAIDs in sciatica (1.2.20) and use “the lowest effective dose for the shortest possible period of time” (1.2.21); consider epidural injections of local anaesthetic and steroid “in people with acute and severe sciatica” (1.3.5), but “Do not use epidural injections for neurogenic claudication in people who have central spinal canal stenosis” (1.3.6); BMI, smoking status or psychological distress should not influence referral for a surgical opinion (1.3.7); consider spinal decompression when non-surgical treatment has not improved pain or function and imaging is consistent with the symptoms (1.3.8). The recommendations on psychological therapy and combined programmes were withdrawn in July 2026.
5. Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. New England Journal of Medicine. 2007;356(22):2245–2256. doi:10.1056/NEJMoa064039 (PMID 17538084).
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   283 people with severe sciatica for 6 to 12 weeks: 39% of those assigned to conservative treatment had surgery, after a mean of 18.7 weeks; “Relief of leg pain was faster for patients assigned to early surgery”; at 1 year “the probability of perceived recovery” was 95% in both groups.
6. American Academy of Orthopaedic Surgeons, OrthoInfo. Cauda equina syndrome. Checked October 6, 2026.
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   A rare disorder of “the bundle of nerve roots (cauda equina) at the lumbar (lower) end of the spinal cord” and “a surgical emergency”; see your doctor immediately for bladder or bowel dysfunction (unable to urinate or to hold urine) or severe or worsening loss of or altered sensation between the legs, over the buttocks, in the inner thighs or back of the legs, or in the feet; without immediate treatment it can cause permanent paralysis and impaired bladder and bowel control; emergent surgery is usually recommended; “earlier treatment does, however, offer the best outcomes.”
7. NHS. Sciatica. Page last reviewed December 3, 2024. Checked October 6, 2026.
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   “Sciatica usually gets better in a few weeks to a few months, but it can sometimes last longer. It can also return if you’ve had it before”; symptoms “usually affect your bottom and the back of one leg, often including your foot and toes”; back pain is “not usually as bad as the pain in your leg,” and “You probably do not have sciatica if you only have back pain”; spondylolisthesis is “when one of the bones in your spine slips out of position”; carry on with normal activities, start gentle exercise as soon as you can and use heat packs; “paracetamol is unlikely to help and it’s not clear how much NSAIDs, such as ibuprofen, help with sciatica”; “do not sit or lie down for long periods – even if moving hurts, it’s not harmful and can help you get better faster”; see a doctor if it has not improved after a few weeks of home treatment, is getting worse or is stopping your normal activities; go to the emergency department or call an ambulance if you have sciatica on both sides, weakness or numbness in both legs that is severe or getting worse, numbness around or under the genitals or around the anus, or problems peeing or controlling your bowels, and do not drive yourself; prevention: regular exercise, safe lifting, good posture when sitting and standing, sitting correctly at a computer, losing excess weight, and not smoking, since “smoking can increase your risk of getting sciatica.”
8. American Academy of Orthopaedic Surgeons, OrthoInfo. Herniated disk in the lower back. Checked October 6, 2026.
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   A herniated disk “happens when one of the soft cushions between the bones in your spine becomes weak and moves from its normal position”, “most often the result of natural, age-related wear and tear of the spine. This process is called disk degeneration,” in which the disks lose water, shrink and become “more likely to tear or bulge”; it squeezes the nerves and “the disk material also releases chemical irritants that contribute to nerve inflammation”; “Men between the ages of 20 and 50 are the most likely to suffer from a herniated disk”; in the straight leg raise test, pain in the leg that travels below the knee “is a strong sign that you have a herniated disk”; “Typically, most patients are free of symptoms by 3 to 4 months. However, some patients do experience episodes of pain during their recovery”; take rest breaks “but avoid sitting for long periods of time,” and keep bending forward and lifting slow and controlled; treatment relieves symptoms “while your body works to heal the disk. In many cases, the disk herniation naturally dissolves over time and is absorbed by the body”; “Only a small percentage of patients with lumbar disk herniations require surgery,” usually after nonsurgical treatment has not helped, or for muscle weakness, difficulty walking or loss of bladder or bowel control; microdiskectomy, through a small incision and often with a microscope, is the most common operation; afterward, a walking program “(such as 30 minutes each day)” and no bending, lifting and twisting for the first few weeks; “With both surgical and nonsurgical treatment, there is up to a 20 to 25% chance that the disk will herniate again in your lifetime”; results of surgery at around 9 to 12 months are not as good as surgery before 9 months; “the first symptom to improve is pain, followed by overall leg strength, and, finally, sensation.”
9. Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews. 2010;(6):CD007612. doi:10.1002/14651858.CD007612.pub2 (PMID 20556780).
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   For sciatica, “moderate quality evidence of little or no difference in pain relief” or function between advice to rest in bed and advice to stay active, and “advice to rest in bed is not a favourable option for patients with sciatica”; one trial of 250 people gave low-quality evidence of little or no difference between physical therapy and either kind of advice.
10. Fernandez M, Hartvigsen J, Ferreira ML, et al. Advice to stay active or structured exercise in the management of sciatica: a systematic review and meta-analysis. Spine. 2015;40(18):1457–1466. doi:10.1097/BRS.0000000000001036 (PMID 26165218).
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    “low-quality evidence (GRADE) that exercise provides small, superior effects compared with advice to stay active on leg pain in the short term,” and “moderate-quality evidence showing no difference between advice to stay active and exercise on leg pain and disability status in people with sciatica in the long term.”
11. Enke O, New HA, New CH, et al. Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis. CMAJ. 2018;190(26):E786–E793. doi:10.1503/cmaj.171333 (PMID 29970367).
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    Nine trials of topiramate, gabapentin and pregabalin: “moderate- to high-quality evidence that anticonvulsants are ineffective for treatment of low back pain or lumbar radicular pain,” and “high-quality evidence that gabapentinoids have a higher risk for adverse events.”
12. Liu C, Ferreira GE, Abdel Shaheed C, et al. Surgical versus non-surgical treatment for sciatica: systematic review and meta-analysis of randomised controlled trials. BMJ. 2023;381:e070730. doi:10.1136/bmj-2022-070730 (PMID 37076169).
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    In sciatica from a herniated disk with a surgical indication, discectomy reduced leg pain more than non-surgical care by a moderate amount up to 3 months and a small amount up to 12 months, with “Negligible effects” at 12 months, on very low to low certainty evidence; adverse events were similar; “non-surgical treatment can achieve similar results, although at a slower pace and with a potential chance of requiring delayed surgery.”
13. American Academy of Orthopaedic Surgeons, OrthoInfo. Lumbar spinal stenosis. Checked October 6, 2026.
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    “a common cause of low back and leg pain, or sciatica”; “By age 50, up to 95% of people have some wear and tear” in the spine, and “Spinal stenosis happens most often in adults over 60 and affects men and women equally”; “Arthritis is the most common cause of spinal stenosis”; burning pain, numbness or tingling in the buttocks or legs, and weakness that “can occur in one or both legs,” including foot drop, “the feeling that their foot slaps on the ground while walking”; “People with spinal stenosis often feel better when they lean forward or sit down,” because leaning forward “can increase the space available for the nerves”; some can ride a stationary bike or walk leaning on a shopping cart, while “Walking more than 1 or 2 blocks, however, may bring on severe sciatica or weakness”; stretching, massage and core strengthening “often help manage symptoms”; NSAIDs “can lead to gastritis, stomach ulcers, and kidney problems”; “Chiropractic manipulation is generally safe and can help with some of the pain from lumbar stenosis. Take care, however, if you have osteoporosis or a herniated disk.”
14. American Physical Therapy Association, ChoosePT. Physical therapy guide to lumbar radiculopathy (sciatica). Reviewed November 20, 2017. Checked October 6, 2026.
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    Lumbar radiculopathy, “also known as sciatica or radiculitis,” occurs when a nerve in the low back is “injured, pinched, or compressed”; “It most often affects people aged 30 to 50 years”; risk factors “include repeated lifting, participating in weight-bearing sports, obesity, smoking, sedentary lifestyles, and poor posture”; injuries that can press on the nerve roots include bulging disks and a “Tight piriformis muscle”; “The majority of lumbar radiculopathy and sciatica cases recover without surgery, and respond well to physical therapy”; “Greater irritation causes the pain to spread farther. Spreading pain usually affects 1 leg, but may affect both legs. Pain and other symptoms can be constant or come and go, and can vary in intensity”; symptoms “can be in different locations at different times”; symptoms include difficulty getting up from a chair, being “stuck” stooped forward, being unable to stay in one position for long, and limping; the evaluation asks how and when the pain started, when it is worse, where it is felt and what you cannot do, and tests movement, strength, sensation, reflexes, posture, walking and balance; “improvement may be achieved in 4 to 8 weeks, when a proper posture, pain reduction, stretching, and strengthening program is implemented”; in the first 24 to 48 hours, avoid activity that worsens symptoms such as heavy lifting, avoid too much bed rest, take short walks several times a day, apply ice packs “for 15 to 20 minutes every 2 hours,” and sit in firm chairs, since “Soft couches and easy chairs may make your problems worse”; “Water exercises can be a great way to stay physically active when other forms of exercise are painful”; exercises found to reduce your leg pain “are important for you to do,” while those with “lots of twisting and bending may or may not benefit you”; flexibility, strength and “core strengthening” work, and a home program; prevention: posture when sitting, standing and driving, body mechanics for lifting, a healthy weight, not smoking, and continuing the home-exercise program and staying active.
15. Konstantinou K, Dunn KM. Sciatica: review of epidemiological studies and prevalence estimates. Spine. 2008;33(22):2464–2472. doi:10.1097/BRS.0b013e318183a4a2 (PMID 18923325).
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    Across 23 studies, “Sciatica prevalence from different studies ranged from 1.2% to 43%,” the spread owing to “differences in definitions, methods of data collection and perhaps populations studied”; sciatica “is more persistent and severe than low back pain, has a less favorable outcome and consumes more health resources.”
16. MedlinePlus, US National Library of Medicine. Spinal stenosis. Checked October 6, 2026.
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    “Most often, symptoms will be on one side of the body, but may involve both legs”; symptoms “are more likely to be present or get worse when you stand or walk. They often lessen or disappear when you sit down or lean forward”; “Most people with spinal stenosis cannot walk for a long period without having significant pain.”
17. American Physical Therapy Association. Direct access advocacy. “As of July 1, 2025, all 50 states, the District of Columbia, and the U.S. Virgin Islands have either provisional or unrestricted direct access to physical therapist services for evaluation and treatment,” though some provisions tied to treatment without a referral persist in a number of states. Checked October 6, 2026.
18. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology. 2015;36(4):811–816. doi:10.3174/ajnr.A4173 (PMID 25430861).
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    33 studies, 3,110 people with no back pain: disk degeneration in 37% at age 20 and 96% at 80, disk bulge 30% and 84%, protrusion 29% and 43%, annular fissure 19% and 29%; “Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.” Published online November 27, 2014; the April 2015 issue is cited.
19. Chiu CC, Chuang TY, Chang KH, Wu CH, Lin PW, Hsu WY. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical Rehabilitation. 2015;29(2):184–195. doi:10.1177/0269215514540919 (PMID 25009200).
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    “The rate of spontaneous regression was found to be 96% for disc sequestration, 70% for disc extrusion, 41% for disc protrusion, and 13% for disc bulging. The rate of complete resolution of disc herniation was 43% for sequestrated discs and 15% for extruded discs”; regression was measured on repeat imaging.
20. George SZ, Fritz JM, Silfies SP, et al. Interventions for the management of acute and chronic low back pain: revision 2021. Journal of Orthopaedic & Sports Physical Therapy. 2021;51(11):CPG1–CPG60. doi:10.2519/jospt.2021.0304 (PMID 34719942). The American Physical Therapy Association guideline.
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    For low back pain with leg pain, physical therapists “may use” exercise training (trunk muscle strengthening and endurance and specific trunk muscle activation in acute pain; specific trunk muscle activation and movement control in chronic pain), thrust or nonthrust joint mobilization, and “neural mobilization in conjunction with other treatments for short-term improvements in pain and disability” in chronic pain, and “should not use mechanical traction,” since “the majority of studies showed no additional benefit” when it was added to exercise and joint mobilization; and, restating its 2012 recommendations, physical therapists should consider “repeated movements, exercises, or procedures to promote centralization” in acute low back pain with referred leg pain, and education should stress “the importance of improvement in activity levels, not just pain relief.”
21. May S, Aina A. Centralization and directional preference: a systematic review. Manual Therapy. 2012;17(6):497–506. doi:10.1016/j.math.2012.05.003 (PMID 22695365). “Centralization is a symptom response to repeated movements”; in 4,745 people with back and neck pain it was seen in 44.4%, “more prevalent in acute (74%) than sub-acute or chronic (42%) symptoms”; “Twenty-one of 23 studies supported the prognostic validity of centralization.”
22. Huang P, Sengupta DK. How fast pain, numbness, and paresthesia resolves after lumbar nerve root decompression: a retrospective study of patient’s self-reported computerized pain drawing. Spine. 2014;39(8):E529–E536. doi:10.1097/BRS.0000000000000240 (PMID 24480941).
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    85 people after surgery for lumbar radiculopathy: “pain recovers fastest, in the first 6 weeks postoperatively, followed by paresthesia recovery that plateaus at 3 months postoperatively. Numbness recovers at a slower pace but continues until 1 year.”
23. Grøvle L, Haugen AJ, Natvig B, Brox JI, Grotle M. The prognosis of self-reported paresthesia and weakness in disc-related sciatica. European Spine Journal. 2013;22(11):2488–2495. doi:10.1007/s00586-013-2871-9 (PMID 23771579).
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    380 people with sciatica from a disk herniation, treated with or without surgery: pins and needles and weakness “improved from baseline to year 2 generally in accordance with improvement in leg pain,” with the largest changes in the first 3 months; at 2 years 18.2% reported bothersome pins and needles, 16.6% bothersome leg pain and 11.5% bothersome weakness, and among people with little or no leg pain, 6.7% still had bothersome pins and needles.
24. Suri P, Rainville J, Hunter DJ, Li L, Katz JN. Recurrence of radicular pain or back pain after nonsurgical treatment of symptomatic lumbar disk herniation. Archives of Physical Medicine and Rehabilitation. 2012;93(4):690–695. doi:10.1016/j.apmr.2011.11.028 (PMID 22464091).
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    79 people whose leg pain from a disk herniation had cleared for at least a month without surgery: 25% had it return within a year, and “The only factor independently associated with radicular pain recurrence was the number of months prior to resolution of pain.”
25. Lurie JD, Tosteson TD, Tosteson AN, et al. Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the Spine Patient Outcomes Research Trial. Spine. 2014;39(1):3–16. doi:10.1097/BRS.0000000000000088 (PMID 24153171).
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    In this US trial, reoperation after disk surgery reached “15% by 8 years post-surgery,” and about 85% of the reoperations whose type was recorded were for recurrent herniation at the same level.
26. American Physical Therapy Association, ChoosePT. Physical therapy guide to herniated disk. Revised April 1, 2025. Checked October 6, 2026.
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    In the first 24 to 48 hours, avoid too much rest, take short walks several times a day and sit in firm chairs; your physical therapist may recommend that you “stand up and move every 30 minutes” and use “a small pillow placed in the lower part of your back when sitting or driving”; “A walking program to gradually improve your tolerance to activity”; once you are pain-free, continue the exercises your physical therapist provided.
27. American Academy of Orthopaedic Surgeons, OrthoInfo. Hip conditioning program. Checked October 6, 2026.
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    A general program to be performed “under your doctor’s supervision”; “Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals”; continue for 4 to 6 weeks, then 2 to 3 days a week for maintenance; warm up with “5 to 10 minutes of low impact activity, like walking or riding a stationary bicycle”; “You should not feel pain during an exercise”; step-by-step directions, repetitions and target muscles for the seated rotation stretch (piriformis), knee to chest and supine hamstring stretch, as given in the exercise cards above.
28. American Academy of Orthopaedic Surgeons, OrthoInfo. Spine conditioning program. Checked October 6, 2026.
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    Warm up with “5 to 10 minutes of low impact activity, like walking or riding a stationary bicycle”; “You should not feel pain during an exercise”; continue for 4 to 6 weeks, then 2 to 3 days a week to maintain strength and range of motion; step-by-step directions, repetitions and target muscles for the bird dog, hip bridge and abdominal bracing, as given in the exercise cards above.
29. Leininger B, Bronfort G, Evans R, Reiter T. Spinal manipulation or mobilization for radiculopathy: a systematic review. Physical Medicine and Rehabilitation Clinics of North America. 2011;22(1):105–125. doi:10.1016/j.pmr.2010.11.002 (PMID 21292148).
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    “There is moderate quality evidence that spinal manipulation is effective for the treatment of acute lumbar radiculopathy. The quality of evidence for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration is low or very low.”
30. Rasmussen-Barr E, Held U, Grooten WJ, et al. Non-steroidal anti-inflammatory drugs for sciatica. Cochrane Database of Systematic Reviews. 2016;(10):CD012382. doi:10.1002/14651858.CD012382 (PMID 27743405).
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    “NSAIDs are no more effective in reducing pain in sciatica than placebo or other drugs”; overall improvement was slightly better, on low-quality evidence, and side effects were more common; the trials followed people for up to three weeks. First published in issue 10, 2016.
31. Machado GC, Maher CG, Ferreira PH, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ. 2015;350:h1225. doi:10.1136/bmj.h1225 (PMID 25828856). “High quality” evidence that paracetamol is ineffective for reducing pain intensity and disability in the short term in people with low back pain.
32. Mathieson S, Maher CG, McLachlan AJ, et al. Trial of pregabalin for acute and chronic sciatica. New England Journal of Medicine. 2017;376(12):1111–1120. doi:10.1056/NEJMoa1614292 (PMID 28328324).
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    “Pregabalin is effective in the treatment of some types of neuropathic pain”; in 209 people with sciatica it “did not significantly reduce the intensity of leg pain” over 8 weeks compared with placebo, and adverse events, including dizziness, were more common.
33. Goldberg H, Firtch W, Tyburski M, et al. Oral steroids for acute radiculopathy due to a herniated lumbar disk: a randomized clinical trial. JAMA. 2015;313(19):1915–1923. doi:10.1001/jama.2015.4468 (PMID 25988461). 269 adults: a 15-day tapering course of prednisone “resulted in modestly improved function and no improvement in pain”; at 3 weeks, 49.2% had an adverse event against 23.9% with placebo.
34. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC clinical practice guideline for prescribing opioids for pain — United States, 2022. MMWR Recommendations and Reports. 2022;71(3):1–95. doi:10.15585/mmwr.rr7103a1 (PMID 36327391).
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    “Nonopioid therapies are at least as effective as opioids for many common types of acute pain,” including low back pain; “Nonopioid therapies are preferred for subacute and chronic pain,” subacute meaning pain lasting 1 to 3 months and chronic more than 3 months.
35. Oliveira CB, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections for lumbosacral radicular pain. Cochrane Database of Systematic Reviews. 2020;(4):CD013577. doi:10.1002/14651858.CD013577 (PMID 32271952).
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    25 trials, 2,470 participants: probably slightly better than placebo for leg pain in the short term (more than 2 weeks up to 3 months), but “the treatment effects are small, mainly evident at short-term follow-up and may not be considered clinically important by patients and clinicians”; probably no effect on leg pain at intermediate and long-term follow-up.
36. Bailey CS, Rasoulinejad P, Taylor D, et al. Surgery versus conservative care for persistent sciatica lasting 4 to 12 months. New England Journal of Medicine. 2020;382(12):1093–1102. doi:10.1056/NEJMoa1912658 (PMID 32187469).
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    128 people with sciatica from an L4–L5 or L5–S1 disk herniation lasting 4 to 12 months: leg pain at 6 months scored 2.8 out of 10 after microdiskectomy and 5.2 with nonoperative care; 34% of the nonsurgical group crossed over to surgery.
37. Dieleman JL, Cao J, Chapin A, et al. US health care spending by payer and health condition, 1996–2016. JAMA. 2020;323(9):863–884. doi:10.1001/jama.2020.0734 (PMID 32125402).
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    “In 2016, among the 154 conditions, low back and neck pain had the highest amount of health care spending with an estimated $134.5 billion,” 57.2% paid by private insurance, 33.7% by public insurance and 9.2% out of pocket.
38. Centers for Medicare & Medicaid Services. Physical therapy services (Medicare.gov). Checked October 6, 2026.
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    Part B “helps pay for medically necessary outpatient physical therapy”; “After the Part B deductible, you pay 20% of the Medicare-approved amount”; your doctor or other provider “must certify that you need it”; “There’s no limit on how much Medicare pays for your medically necessary outpatient therapy services in one calendar year.”

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your individual situation. Seek urgent medical attention for any of the symptoms listed above.