Dr. Steve Paragioudakis On How To Manage Sciatica Pain


Sciatica begins in the hip and buttocks and continues down the leg. It can also include numbness. About 40 percent of Americans experience sciatica pain during their lives, says Steve Paragioudakis, MD, an orthopedic spine specialist. While some people will require surgery to remove the source of pressure on their spinal roots, he says many people can manage sciatica pain in other ways.

Self-Care Remedies

Cold and heat can help with sciatica pain. Use ice packs on your lower back for the first seven days. Wrap the ice pack in a cloth and use it for no more than 15 minutes at a time, and take at least a 20-minute break in between. You can also put ice in a cup and roll it back and forth over the lower back in a circular motion for no more than 10 minutes at a time. 

After the first week, you can use heat to increase the blood flow to the area. Heat also relaxes the muscles so that you can do some gentle stretching. Use a heating pad or a hot water bottle wrapped in a towel. Apply for at least 15 minutes but no longer than two hours. 

Resting for the first few days is good, but after that, movement is critical to easing pain, Dr. Paragioudakis says. Moving strengthens muscles, improves blood flow, and adds flexibility. If moving increases the pain, you should consult a doctor.

You also should consult a doctor if you’ve practiced self-care for several weeks without significant improvement or if the pain has been unbearable for several hours. Loss of bladder or bowel control or numbness are reasons for calling the doctor immediately.


A doctor might prescribe various medications to help ease the pain, including:

  • Anti-inflammatories
  • Anti-seizure medications
  • Corticosteroids
  • Antidepressants
  • Opioids

Physical Therapy

Your doctor also might recommend a physical therapy program that includes stretching, aerobic exercise, improving range of motion, and core strengthening. 


In some cases, an injection of a corticosteroid can help relieve pain and swelling for up to three months. The number of injections a person can receive is limited, however. For most people, the limitation is three per year. However, your doctor will know the limit for you, Dr. Steve Paragioudakis says.


Some people will require surgery to manage sciatica pain. The doctor will consider various factors when determining the type of surgery. Factors include the structural and functional changes that led to the neurological dysfunction, the spine levels affected, and the overall medical history. The surgeon’s expertise is also a factor. Most surgeries are minimally invasive and allow the spine surgeon to dilate muscles surrounding your spine rather than stripping muscles away from the spine. 

The surgeries typically take an hour or two to perform and, depending on the patient’s overall health, and may require a recovery time between six weeks or three months, Dr. Steve Paragioudakis notes.


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