What will a hospital do for sciatica pain? Sciatica can often be treated at home, but there’s times when it’s best to visit a hospital. Sciatica pain can range from mild to debilitating – for more severe or long-lasting cases, a trip to hospital may be the best way to get your pain under control.
Although Accident and Emergency (A&E) is often the first port of call for a severe flare up of sciatica, the painkillers usually given there are only a temporary solution. Sciatica pain that is not resolving on its own needs treatment to address the root cause and achieve long-term relief.
What is sciatica?
Sciatica refers to irritation of the sciatic nerve, the longest nerve in your body. This nerve has a strong effect on your ability to move and feel your legs. Your sciatic nerve runs from your spinal cord, through your hips and buttocks, and down each leg.
If you have sciatica, you may experience discomfort, pain, tingling, burning, weakness or numbness anywhere along the course of your sciatic nerve. Sciatica is caused by an underlying injury to your sciatic nerve or a part of your body that affects this nerve, such as the piriformis muscle in your buttocks.
At what point do you go to hospital with sciatica?
While sciatica pain can usually be treated at home or in a doctor’s office, it may be worth going to hospital if your symptoms aren’t resolving. Usually, treatment for sciatica outside of a hospital includes pain relief, lifestyle changes, exercises and hot/cold therapy. 
If these treatments aren’t working, it could be time to visit a hospital. For severe flare-ups where your pain is unmanageable, a visit to A&E can bring immediate relief for sciatica pain.
Unfortunately, waiting times can be very long in A&E, which is why some people choose same-day private care for relief of sciatica pain. Harley Street Specialist Hospital’s Rapid Orthopaedic Care Centre (ROCC) offers same-day assessment and treatment for chronic pain (pain lasting 3 months or more).
ROCC is a walk-in service with no appointment needed. They can offer assessment, diagnostic imaging and treatment from a team of consultants, physiotherapists, nurses and radiologists.
You should also be aware of symptoms that could indicate a serious condition. If you have sciatica and also experience one of these symptoms, you should seek medical attention straight away:
- Sudden changes to your bladder and bowel function
- Numbness or altered sensation between your legs (‘saddle’ region)
These symptoms along with sciatic pain, particularly bilateral sciatica (sciatica in both legs), can be signs of Cauda Equina Syndrome (CES), a rare but serious condition where the bundle of nerves at the bottom of your spine becomes suddenly compressed. This requires urgent treatment.
Will A&E do anything for sciatica?
If you visit A&E with severe sciatica pain, their first approach is usually pain relief. Here are a few of the medications that you may be offered: 
- Painkillers – You may already be taking over-the-counter (OTC) medications. But for severe sciatica pain, OTC medications may not even touch your pain. A&E may offer stronger non-steroidal-anti-inflammatory drugs (NSAIDs), opioid and non-opioid pain relief medications such as prescribing amitriptyline for sciatica.
- Anticonvulsants – For severe cases of sciatica, anticonvulsant medications like gabapentin can be used for their ability to treat nerve pain. However, these medications are mainly used to treat epilepsy.
- Corticosteroids – Steroid medications are used to reduce inflammation in your body. This can help with sciatica when your pain is due to an inflamed nerve, or another inflamed tissue in your body that is putting pressure on your sciatic nerve.
- Muscle relaxants – Sometimes, sciatic pain can be accompanied or caused by severe muscle spasms in your back, buttocks or legs. Muscle relaxants like diazepam can help to relax these muscles, relieving some of your pain.
If you have any signs of serious conditions like a spinal fracture or CES, you will receive diagnostic imaging to rule these out. Whether you have signs of a serious condition or not, you will also receive advice to follow up with your General Practitioner (GP) to help you manage your sciatica better and avoid further trips to A&E. Find out what treatments are available for sciatica through the NHS.
What will hospital do for sciatica pain?
While A&E can offer fast relief for sciatica pain, the medications they offer give only temporary relief. To achieve long-term relief, you need a comprehensive assessment, diagnosis and treatment.
The first step is finding the root cause of your sciatica pain, which can be done in hospital. There are many causes for sciatica, including:
- Herniated disc – this is a common cause of lower back pain and sciatica. There are discs between your vertebrae (the bones in your spine) and sometimes, all or part of a disc can move out of place and put pressure on your sciatic nerve. Every year, 5-20 people per 1000 adults will experience a herniated disc.  Symptomatic herniated discs are more common in men than women, and most common in people aged 30-50. 
- Spondylolisthesis – this is where one of the bones in your spine slips forwards onto the bone below it. It’s most common in the lower back, and can create pain, sciatica symptoms and instability in your spine.  It can be caused by arthritis in your spine, a fracture, abnormal spine growth from birth, or a bone disease. However, some people have this condition without knowing it for many years before they experience any symptoms.
- Spinal stenosis – this is where the space inside your spinal canal, where your nerves pass through, narrows and can put pressure on your nerves. This is most common in older adults because narrowing is usually due to osteoarthritis in your spine, which is more common in older people. 
- Osteoarthritis of the spine – this is most common in older adults, because osteoarthritis of the spine develops as part of the natural ageing process.  However, sometimes bone spurs formed by arthritis (extra lumps of bony growth) can put pressure on the nerves in your spine and create symptoms of sciatica. These often require treatment.
- Spinal tumour – Primary spinal tumours are a rare condition.  ‘Primary’ refers to tumours that start in the spine. Your doctor may well use diagnostic imaging to rule these out for peace of mind, but they are unlikely to be the cause of your sciatic pain.
Hospitals may use diagnostic imaging such as X-Rays, Magnetic Resonance Imaging (MRI) and ultrasound scans to identify the cause of your symptoms. At Harley Street Specialist Hospital, imaging can be arranged as part of the ROCC service – our walk-in, rapid access diagnosis and treatment service. We also offer assessment and diagnostic imaging by appointment.
Once you have the right diagnosis, the next step is treatment. Treatment varies widely depending on the cause of your symptoms, the severity of your pain and how you would prefer to be treated. Hospital-based treatment options include:
- Pain management services
- Spinal surgery
Physiotherapy for sciatica can help to reduce pain while improving the movement and function of your spine.  Physiotherapy can include exercises, advice, pain education, massage and manual therapy. The type of physiotherapy that could work best for you depends on you as a person and the physical cause of your sciatic pain.
Physiotherapy is available on the NHS, but there can be long waiting times and a limited number of sessions available per person. Harley Street Specialist Hospital offers rapid access to physiotherapy for sciatic pain. This is available before surgery, after surgery, and as a standalone service.
Pain management services
A pain management team can help select the best pain relief, but can also help with more permanent solutions for sciatica pain. Harley Street Specialist Hospital’s Pain Management Unit is a prime example of a well-rounded pain management service.
Our team consists of world-leading experts in pain management, with a daily clinic that provides assessment and treatment often within the same visit. Our senior experts in pain management include radiologists, physiotherapists, pain management consultants, spinal surgeons and neurosurgeons. Our treatments include:
- Steroid injection (ultrasound guided) – Ultrasound guided injections allow the specialist to clearly see the affected area, and make sure they inject the area causing the most pain. Steroid injections (also known as corticosteroid injections) are anti-inflammatory medications. If an inflamed nerve or tissue is causing your sciatica, steroid injections may relieve your symptoms.
- Viscosupplementation into joint injection (ultrasound guided) – This is an injection of hyaluronic acid (HA) into joints that are causing pain, particularly arthritic joints. HA spinal injections help the joints to move more easily and can reduce pain.
- Nerve block (ultrasound guided) – nerve block injections can be used to diagnose and treat sciatica. The injection turns off the pain signals for the affected nerve. This is a temporary solution, but can provide immediate relief for a couple of weeks and if successful, provides a clear diagnosis. This paves the way for more permanent solutions like Radiofrequency Ablation, which destroys the nerve tissue causing your pain.
- Platelet Rich Plasma (PRP) – This is a type of regenerative medicine that uses platelets from your own blood. Injecting a concentrated dose of these platelets can improve or stimulate the healing of injured tissue in your body. PRP is also an available treatment for sacroiliac joint pain on the NHS.
If less invasive treatments aren’t successful, the final option is surgery. This can permanently relieve the pressure on your sciatic nerve. Surgical options for sciatica pain include:
- Discectomy – This is often performed as a microdiscectomy, which is a less invasive type of surgery. With a discectomy or microdiscectomy, all or part of a herniated disc is removed. If the herniated disc was the source of your sciatica, your symptoms should resolve.
- Laminectomy – This is where your spinal canal (where nerves pass through) is expanded to create more space for the nerves. Each bone in your spine has two laminae that form the roof of your spinal canal. All or part of a lamina is removed to take pressure off your nerves.
- Artificial disc surgery – If you have a damaged disc in your back that’s causing your sciatic pain, this disc can be removed and replaced with an artificial one.
- Spinal fusion – This increases stability in your spine by fusing some of your vertebrae (back bones) together. This is often the treatment for back conditions like spondylolisthesis, which can cause spinal instability and sciatica.
Tips for immediate relief of sciatica pain
If you’re struggling with sciatica right now, here are a few things you can try before you visit a hospital:
- Hot or cold therapy – ice and heat can both be helpful when you’re struggling with sciatic pain. This can be applied directly to your back, or to the area of the leg or buttock that is most painful. Heat can soothe and relax tight muscles, while ice can help with inflammation and muscle spasms.
- Gentle movement – it’s best to speak to a physiotherapist before starting a programme of home exercises. But you can try slowly and gently stretching your back and legs, stopping any movement that feels like it’s worsening your pain. If you find a movement helps your pain, you can repeat that stretch. Sometimes, going for a gentle walk can also improve sciatic pain.
- Over the counter (OTC) painkillers – OTC pain relief like paracetamol and ibuprofen can provide some relief for mild to moderate sciatica. If you find that OTC medications don’t help your pain at all, speak to your GP who can prescribe alternative pain relief.