Posture & Back Pain

There are a range of treatment options available for people who suffer from sciatic nerve pain. In a lot of cases home remedies, lifestyle modification, rest, and proper self care can relieve ongoing sciatica. But when the pain is stubborn and/or prevents you from daily functioning, additional treatment might be necessary.

Often the first line of clinical treatment includes a combination of physical therapy and pain management. Medication is frequently used in treatment. Non-steroidal anti-inflammantory drugs (NSAID) are by far the most common over-the-counter medications. Prescription medications for sciatic nerve pain can also be a part of treatment, typically if over-the-counter drugs don't help alleviate symptoms.

This guide will summarize how doctors use medication to treat sciatic nerve pain. We completed a PubMed search for “sciatica medication” and “medications for sciatic nerve pain”, and also researched the top academic health websites. Our guide is a roundup summary of what the experts in the field of pain management have to say on the topic.

Note that this is not an endorsement of any particular medication. Most of the discussion on back pain has been about correcting bad posture and exploring natural pain management techniques. But without a doubt, prescription medication can sometimes play an important role in treating back pain and sciatica, and thus it is worth summarizing here.

Disclaimer: Always consult your physician for questions about any particular treatment or medication.

Guidelines For Treating Sciatic Nerve Pain With Medication

Every physician guideline recommends the use of medication as one part of a multi-disciplinary treatment approach. There are many effective non-pharmacologic treatments for low back pain and sciatica that should be explored, including acupuncture, physical therapy, cognitive therapy, and exercise.

Much of the information about sciatica in the medical includes a discussion of both sciatica and lower back pain, though the two are not synonymous. Thus the following information is applicable to both diagnoses.

The National Institute for Health and Care Excellence (NICE) in the United Kingdom has provided useful guidelines for using both prescription and non-prescription medications to treat sciatica.

To summarize, the Institute recommends beginning with oral NSAIDs to manage low back pain, at the minimum effective dose and for the shortest period of time. If NSAIDs do not work or aren't tolerated, doctors can consider “using weak opioids (with or without paracetamol)”. Interestingly, NICE advises against offering antidepressant medications for managing low back pain .

Physician best practices for sciatica treatment in the United States overlap with the recommendations made by NICE. Use of NSAIDs is the recommended first-line treatment. However the American College of Physicians recommends use of tramadol and duloxetine (a serotonin–norepinephrine reuptake inhibitor antidepressant) as the second line of treatment, in contrast with NICE.

Non-Steroidal Anti-Inflammatory Medications

For pharmacologic treatment of sciatica and low back pain, NSAIDs are the recommended first line.

Doctors recommend low-dose medications that can be purchased over the counter, such as Ibuprofen or Tylenol. The over-the-counter NSAIDs are meant to provide pain relief. Prescription NSAIDs may be necessary for pain relief if over-the-counter drugs are ineffective. However, sciatica is not characterized by inflammation, and so the anti-inflammatory properties of prescription NSAIDs are unhelpful.

Whether over-the-counter or prescribed, NSAIDs are only meant to be taken for a short period. These drugs raise the risk of heart attack and stroke and may cause kidney damage if used too frequently. Most professionals advise against taking NSAIDs for more than 10 days. If your pain is not responding adequately to NSAIDs, a different medication might be in order.

If your sciatic nerve pain does not respond to NSAIDs, you're not alone. A systematic review found that most people experience only a minor improvement in pain when using NSAIDs as compared to placebo.

Antidepressants

As we noted earlier, there is some disagreement about the appropriate role for prescription antidepressants in treating back pain and sciatica. But plenty of physicians consider antidepressants to be an important part of a multidisciplinary approach to treating pain.

As neurosurgeon Dr. Jason Highsmith writes for Spine Universe:

While the pain-relieving ability of an antidepressant isn’t fully understood, it’s believed that these drugs work in the central nervous system (which includes your brain and spinal cord) to reduce pain signals. This is why antidepressants are particularly well-suited for people with neuropathic pain—that is pain that originates from the nerves. Fibromyalgia is an example of a neuropathic pain condition.

Excerpt from original article published here.

He also notes that antidepressants can help with sleep and anxiety, both of which can affect daily pain levels.

There are several different classes of antidepressants. The most commonly prescribed are selective serotonin-reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants. The most appropriate antidepressant will depend on a variety of factors. Treatment of sciatica with antidepressants will be for a longer time period than NSAID treatment.

Opioids

Opioid drugs are effective for relieving back pain, though given their potential for addiction they should only be used when other treatments fail to address symptoms. They are used in clinical settings for acute back pain that requires immediate relief, and to treat long-term chronic back pain.

Treatment with opioids should be closely monitored, and should only happen when other options are insufficient.

Common opioid drugs for sciatica include Vicodin, OxyContin, Duragesic, Demerol, and Ultram. Each of these drugs has a similar mechanism for relieving pain symptoms.

Muscle Relaxants

Since sciatic nerve pain is distinct from muscular pain, the frequently-prescribed muscle relaxants for back pain may be ineffective for sciatica. However, people who suffer from a combination of low back pain and sciatica may find at least some relief with muscle relaxants, especially if they experience muscle spasms in their low back.

Conclusion

Prescription medications for sciatica may be necessary to provide treatment and pain relief. They are best used as part of a multi-disciplinary approach that also includes non-pharmaceutical interventions.

If you look at the average adult these days you'll probably notice that their head is almost always tilted forward. And if you use a smartphone or spend any time at a desk, you probably have it too.

There are many names for this phenomenon: text neck, forward head posture, buffalo hump, etc. The medical term for it is anterior head carriage.

Anterior head carriage should concern you. Not only does it look bad, it actually hurts your health. People who have this forward head posture for too long can develop serious neck and back pain, decreased energy, brain fog, and accelerated aging. Got your attention now?

Hunchback Correction: Where To Begin

The good news is that there are plenty of ways to re-align your head, neck and upper back. But unless you're already working with a physical therapist it's hard to know exactly what to do.

I have written about my top recommended program by Rick Kaselj, physical therapist. And I do suggest you start there. If your neck and shoulders are as tight and weak as most people then doing this daily routine will make a fast difference. (I've been personally using the program for over a year now.)

But there's more you can do in addition to following Rick Kaselj's program. I spent a long time researching what the experts say and I'll summarize what I've learned below.

How To Achieve Your Ideal Posture

The following suggestions are based on the research I've done. What I looked for were common themes among experts. Here's what I found.

Choose An Ergonomic Screen Height and Sitting Posture

When you're sitting at your desk, your back is most likely hunched. Even if you think you sit fairly straight, try to self-assess in the mirror – you'll probably be surprised what you really look like.

There's an easy fix for this: adjust your computer screen height. You shouldn't be looking down at your computer screen. Nor is it good for you to be eye-level with your screen if it means you have to hunch over. Instead, sit as straight as possible and then move your screen so that you get your best view by looking straight ahead. If you don't have an adjustable desk you can just stack something flat and sturdy like books underneath until you're at an acceptable height.

To help further, try putting a cushion behind your back that forces you to sit toward the front of your chair seat. A good cushion can help you keep your spine straight while your back and core muscles get stronger. After a certain point you might not need a cushion but you definitely will at the beginning.

Hold Your Phone At Eye Level

Instead of always looking down at your phone, keep your eyes and head forward and hold your phone up to eye level. As you can probably guess, smartphones are one of the biggest reasons we have anterior head carriage so changing the way you use it is a must. Holding your phone level will take some getting used to but eventually it will become habit.

Gym Exercises To Correct Rounded Shoulders

Some of the best gym exercises to straighten your head and neck posture are actually core routines. Like I mentioned earlier, most of us have core weakness that makes it hard to sit or stand straight for the whole day.

You'll also want to add some resistance pulling to your workout. Try to add exercises like face pulls or seated rows to your usual routine. When you're just starting out, don't worry too much about how many reps or sets you do. Just doing these exercises with some light resistance will help begin the process of strengthening your weak and tight upper back muscles.

Shoulder Hangs

This is a simple stretch that I've seen multiple fitness experts recommend.

1. Grab hold of a pull up bar
2. Hang and let gravity gently pull your torso downward

Be careful, though. Most of us have extremely tight shoulders so hanging without any support beneath you might be too intense. Instead try to ease into it by either grabbing a bar that's low enough that your feet can still touch the ground, or place a platform underneath your feet. Eventually you'll loosen up and will be able to hang freely, but don't rush into it.

Practice Yoga Regularly

Yes, I know, yet another post raving about the benefits of yoga. But I can't write about fixing your posture without at least mentioning yoga. Just a standard yoga class will help reduce your anterior head carriage greatly.

It's not just because you stretch your shoulders and strengthen your posture, but you also improve mobility throughout your whole body. This is important. Since our bodies are interconnected, if you suffer from tight hips or hamstrings, it ends up affecting other muscle groups and hurting your posture. The stretching and mobility work you get in yoga is unparalleled and will help you eliminate your forward head posture quicker.

Consider Using A Better Posture Brace

If you're really struggling to practice good posture, a brace could help. There are plenty on the market and you can find one that you can wear discreetly under your normal clothes. A brace will help you develop the muscle memory to maintain good posture. Keeping your shoulder back will help make it a habit for your body and nervous system.

How To Choose A Posture Brace?

This might be a topic for a future post, but for now I suggest you either talk to your doctor/physical therapist, or at least look at the ratings and reviews on Amazon to get an idea of what to get.