The best anti-inflammatory for sciatica in 2024

What if the best anti-inflammatory for sciatica was a…Placebo? A “placebo” is a kind of false treatment, such as a sugar capsule.

That said, no, it seems that in 2024, we have anti-inflammatories that can still do a little better than a placebo to relieve sciatica.

To determine this “a little better”, I have examined in detail the latest major scientific syntheses on the subject. This article is the result of that work.

Happy reading! 🙂

(Any questions, comments or experiences to share? Feel free to use the comments section at the end of the article! 🙏)

♻️ Last updated: February 2024. Written by Albin Guillaud, physiotherapist and doctor of public health
👨‍⚖️ Declaration of financial interests: no past or present links with the pharmaceutical industry. See my full declaration in the legal section.

The best anti-inflammatory for sciatica: a corticosteroid?

More on these results later. In the meantime, let’s hear my answer:

Unfortunately, however, it should be noted from the outset that even this treatment would have little more than a short-term effect on sciaticpain .

In other words, there’s little chance that this type of substance can really help you out of a crisis.

One possible reason is that in 2024, we’re not even sure that sciatica problems are really inflammatory problems [Jungen, 2019].

All of which raises the question of the value of venturing into this kind of treatment (as opposed to sciatica exercises, for example).

In any case, since corticosteroids are only available on prescription in France, a doctor has to think the game is worth playing before accessing them.

(The good news is that the duration of sciatica is usually quite short, even without treatment!)

Having said all that, if you’d like to know how I arrived at my answer, I invite you to read the following section.

Sources: Rasmussen-Barr, 2016; Jungen, 2019; Oliveira, 2020; Chou, 2022

How to choose the best anti-inflammatory for sciatica?

To arrive at the answer presented in the previous section, I examined :

• scientific evidence of the efficacy of different categories of anti-inflammatory drugs in treating sciatica;
• the risks of adverse effects associated with these same categories.

Indeed, assessing the value of a treatment always means (at the very least) weighing up its benefits against its potential drawbacks.

That’s what I’ve tried to do in the rest of this article. Having said that, here’s a condensed version of my reasoning:

1️⃣ To relieve sciatica, there are two classes of anti-inflammatory drugs:

• non-steroidal anti-inflammatory drugs (NSAIDs)
• steroidal anti-inflammatories (also known as glucocorticoids, or simply corticoids).

2️⃣ In 2024, there is still noconclusive evidence that NSAIDs are effective for sciatica.

3️⃣ On the other hand, better-quality evidence shows that corticosteroids have a positive effect, albeit small and short-term.

4️⃣ Of the various ways of using corticosteroids, the oral route (by mouth) is the safest (no need to pierce the skin).

5️⃣ The most seriously studied oral corticosteroid for sciatica is prednisone [Goldberg, 2015; Chou, 2022].

6️⃣ The treatment durations studied ranged from a single dose to a maximum of 15 days, with a gradual reduction in dose.

For more details, please read the rest of this article.

Sources: Goldberg, 2015; Rasmussen-Barr, 2016; Oliveira, 2020; Chou, 2022

Anti-inflammatories and sciatica: how effective are they?

For the record, there are two types of anti-inflammatory drugs:

• non-steroidal anti-inflammatory drugs (NSAIDs)
• steroidal anti-inflammatories (also known as glucocorticoids, or simply corticoids).

For each of these anti-inflammatory categories, let’s now look at the evidence of efficacy for sciatica.

Efficacy of non-steroidal anti-inflammatory drugs (NSAIDs)

In 2016, a research team collected and analyzed all studies on the effects of NSAIDs for sciatica [Rasmussen-Barr, 2016].

So I’m going to describe this synthesis right here. Please note that as of this writing (February 2024), there have been no new studies since.

Of the many non-steroidal anti-inflammatory drugs available, 7 have been studied for the treatment of sciatica:

Name of non-steroidal anti-inflammatory drug	Trade names in France
Diclofenac	Voltarene
Indomethacin	Indocid
Ketoprofen	Ketum, Spondylon
Lornoxicam	Xefo, Xafon, Lorcam, Acabel
Meloxicam	Mobic
Phenylbutazone	Brexidol, Durapirox, Felden, Flexase
Piroxicam	No longer authorized for use in humans

The researchers examined the effects of these NSAIDs on different aspects of a sciatica episode, such as:

• PAIN;
• function, i.e. the extent to which the pain interferes with activities of daily living;
• theoverall improvement felt.

They also examined the occurrence ofadverse events.

What were their conclusions? To treat sciatica, non-steroidal anti-inflammatory drugs :

➡️ are no more effective than a placebo in reducing short-term pain (very low-quality evidence);

➡️ are no more effective than a placebo in improving function (very poor quality evidence);

➡️ are more effective than a placebo in achieving short-term overall improvement (poor-quality evidence).

Regarding this last point, may I add that :

1. the effect obtained is very small;
2. Having examined in detail the best study on the subject [Herrmann, 2009], I have my doubts as to whether this effect is real.

Sources: Herrmann, 2009; Rasmussen-Barr, 2016

The efficacy of steroidal anti-inflammatories (corticoids)

There are two main ways of using corticosteroids for sciatica:

1️⃣ the product is brought in through one point so that the substance diffuses throughout the body. You can do this:

• by swallowing the product ( oral intake);
• by injecting the product into a muscle ( intramuscular injection);
• by injecting the product into a vein ( intravenous injection).

This first method is called systemic, because the product spreads throughout your body system, not just where you’d like it to act.

2️⃣ The second method involves injecting the product as close as possible to the suspected inflammatory area, i.e. in thespace around the spinal cord.

This space, inside the spinal column, is called theepidural space. These are calledepidural corticosteroidinjections .

To answer this question, I examined two major summaries of the international scientific literature:

• one published in 2020, on the efficacy of epidural corticosteroid injections [Oliveira, 2020] ;
• the other published in 2022, on the efficacy of systemic corticosteroids [Chou, 2022].

Of the many corticoids available, 6 have been studied for the treatment of sciatica:

Corticoid name	Method of administration studied
Betamethasone	Epidural injection only
Dexamethasone	Epidural injection and systemic intake
Methylprednisolone
Prednisolone
Prednisone
Triamcinolone

The conclusions of these two syntheses on the benefits of these two methods are almost identical. Here is a summary:

➡️ there is little positive effect of these two therapeutic methods on pain intensity and short-term function.

➡️ specifically for epidural injections, there would also be little positive effect on long-term function.

By “function”, we mean the extent to which pain interferes with your daily activities. For the same pain, this discomfort can vary from one person to another.

➡️ specifically, when taken systematically, they have no effect on the risk of undergoing surgery, or on quality of life.

Remarks :

• For the second point, specific to epidural injections, the authors of the summary specify that their conclusion is based on one study only;
• Overall, these same authors are moderately confident in the validity of their conclusions.

Sources: Oliveira, 2020; Chou, 2022

What are the risks of taking anti-inflammatory drugs for sciatica?

Once again, I study the risks for each anti-inflammatory category separately.

The risks of non-steroidal anti-inflammatory drugs(NSAIDs)

In the first part, I presented a summary of the scientific literature on the efficacy of non-steroidal anti-inflammatory drugs for sciatica.

The authors of this synthesis also examined the adverse events that occurred in the studies they reviewed. Here is their conclusion on this subject:

➡️ Taking NSAIDs during sciatica increases the risk ofmoderate side effects, even for short-term treatment.

Among these adverse effects, the researchers observed the following problems:

🔺Stomachburn;

🔺dyspepsia (discomfort felt in the stomach) ;

🔺headache ;

🔺belly ache;

🔺nausées ;

🔺vertigo.

For example :

• possible increased risk of heart attack (“myocardial infarction”) or stroke;
• a wide range of allergic skin, respiratory and general reactions;
• digestive hemorrhage ;
• skin reaction to sunlight or UV exposure;
• exceptionally, a skin detachment that can extend very severely over the entire body;
• a whole range of digestive disorders of varying degrees of severity;
• and much more besides (for more details, please consult this online manual).

Sources: Herrmann, 2009; Public drug database

The risks of corticosteroids

In this section, I examine the risks of epidural corticosteroid injections separately, followed by those of systemic injections.

Risks of epidural corticosteroid injections

Regarding the risks of epidural injections, the authors of the previously described review state [Oliveira, 2020]:

⚫ that it is highly uncertain whether corticosteroid injections present a greater risk of minor adverse effects than placebo injections.

Among theseminoradverse effects, the researchers were able to observe:

🔺pain during and after injection;

🔺headaches with no identifiable origin ;

🔺headaches related to accidental spinal cord puncture;

🔺chest pain;

🔺appearance of redness in areas other than the injection site;

🔺malaise vagal with brief loss of consciousness ;

🔺hypotension ;

🔺nausées ;

🔺tinnitus.

⚫ That one study described a major reaction to corticosteroids in a person on anticoagulants: bleeding into the abdominal cavity (retroperitoneal hematoma).

Example: bleeding between the spinal column and the spinal cord (epidural haematoma), leading to spinal cord compression and neurological disorders.

Sources: Oliveira, 2020; Alkudari, 2016; Smuin, 2016; Rev Presrire, 2014

The risks of systemic corticosteroids

With regard to the risks ofsystemic corticosteroid use, the authors of the review described above [Chou, 2022] make the following comments (simplified):

⚫ in the case ofsingle-dose or short-term treatment, systemic corticosteroids did not lead to additional adverse effects.

⚫ However, this statement should be taken with a grain of salt, as some studies :

• or do not mention side effects at all (which is contrary to modern research best practice in this field);
• or talk about them in an insufficiently rigorous way.

Let’s take a look at the package insert for a box of standard corticosteroids to get an idea of possible side effects. For example:

🔺severe allergic reactions :

🔺heart failure;

🔺 Mood disorders;

🔺sleep disorders;

🔺a serious mental disorder;

🔺 a whole range of digestive disorders;

🔺diverse skin disorders ;

🔺and many more (for more details, please consult this online manual).

⚠️ Attention ⚠️

For the record, corticosteroids can be used systemically in 3 ways:

• by swallowing the product ( oral intake);
• by injecting the product into a muscle ( intramuscular injection);
• by injecting the product into a vein ( intravenous injection).

In the case of injections, the risks associated with piercing the skin (e.g. infection) must be added to the adverse effects described above.

Sources: Chou, 2022, Public Drug Database

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