What are the recommended first-line treatments for a patient presenting with acute sciatica symptoms?

For a patient presenting with acute sciatica symptoms, the recommended first-line treatment includes providing advice and information tailored to their needs to help them self-manage, including reassurance and encouragement to keep active ³.

Pharmacological treatment options are limited, but NICE recommends considering oral NSAIDs at the lowest effective dose for the shortest possible period, taking into account the person's risk factors and monitoring for adverse effects ¹.

Weak opioids (with or without paracetamol) may be considered only if NSAIDs are contraindicated, not tolerated, or have been ineffective, and should be used with caution and for the shortest duration necessary ¹.

It is advised not to routinely offer paracetamol alone or opioids for managing acute sciatica ¹.

Manual therapy, such as spinal manipulation, mobilisation, or massage, may be considered as part of a treatment package including exercise, but not as a standalone treatment ¹.