How can I effectively counsel patients on the expected prognosis and recovery timeline for radiculopathy following conservative treatment?

Effective counselling on prognosis and recovery timeline for radiculopathy following conservative treatment involves:

• Explaining that most people with radiculopathy (sciatica) improve with conservative management, which includes advice to stay active and self-management strategies tailored to their needs and capabilities.

• Informing patients that acute radiculopathy is defined as symptoms lasting less than 3 months, and many improve within this period with non-invasive treatments such as exercise programmes and manual therapy combined with psychological approaches if needed.

• Reassuring patients that imaging is not routinely required unless symptoms worsen or specific serious pathology is suspected, as imaging does not usually change management in primary care.

• Advising that pharmacological treatments are limited; NSAIDs may be used at the lowest effective dose for the shortest time, but opioids, gabapentinoids, and corticosteroids are not recommended due to lack of benefit and potential harm.

• Highlighting that if symptoms persist beyond 3 months or function worsens, referral for specialist assessment may be considered, including possible spinal decompression if non-surgical treatments fail and imaging confirms nerve root compression consistent with symptoms.

• Encouraging return to normal activities and work as soon as possible to support recovery.

In summary, patients should be counselled that recovery from radiculopathy with conservative treatment is expected within weeks to a few months, with most improving by 3 months, but ongoing symptoms may require further assessment.