whats 1st line mx of sciatica

First-line management of sciatica involves providing reassurance, advice to remain active, and guidance on self-management tailored to the individual's needs and capabilities.

For people likely to improve quickly and have a good outcome, simpler and less intensive support is recommended, including encouragement to continue normal activities and information about the condition.

Pharmacological treatment is not routinely recommended due to lack of clear evidence of benefit; however, NSAIDs may be considered at the lowest effective dose for the shortest possible period, taking into account individual risk factors.

Opioids, gabapentinoids, benzodiazepines, antidepressants, and other antiepileptics are not recommended due to lack of evidence and potential harms.

For people at higher risk of poor outcome, referral for group exercise programmes, physiotherapy including manual therapy as part of a package with exercise, and psychological therapies using a cognitive behavioural approach may be considered.

Imaging is not routinely offered unless red flag symptoms or signs are present.

Patients should be advised to seek follow-up if symptoms worsen, persist beyond 2 weeks, severe pain does not subside within 1 week, new symptoms develop, or symptoms recur.

Return to work or normal activities should be promoted and facilitated.

Foot orthotics, belts, corsets, rocker sole shoes, traction, acupuncture, ultrasound, TENS, and PENS are not recommended.

This approach is based on risk stratification using tools such as the Keele STarT Back Screening Tool to guide the intensity of management.

Overall, the emphasis is on non-invasive, non-pharmacological management with cautious use of NSAIDs if needed, and avoidance of medications with unfavorable risk-benefit profiles.

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