# Sciatica (lumbar radiculopathy) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: NICE Guideline NG59 · Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) · MSF Essential Drugs 2024 - paracetamol (oral) · NICE NG59 evidence review, pharmacological management of sciatica, 2020 (NCBI Bookshelf NBK562934) - Verified date: 2026-08 ## Verified against - Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) - MSF Essential Drugs 2024 - paracetamol (oral) - Sciatica - disease-level clinical article (sciatica-full.txt) ## Treatment metadata - Naproxen — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) - Paracetamol — 500 mg — oral.solid ## Complete treatment card ```text SCIATICA (LUMBAR RADICULOPATHY) Sources: NICE Guideline NG59 · Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) · MSF Essential Drugs 2024 - paracetamol (oral) · NICE NG59 evidence review, pharmacological management of sciatica, 2020 (NCBI Bookshelf NBK562934) Review status: REVIEWED against Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639), MSF Essential Drugs 2024 - paracetamol (oral), Sciatica - disease-level clinical article (sciatica-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (2) - Pain in the low back radiates down one leg, sometimes with a burning, paresthesia-like feeling deep in the buttock [tingling] - The affected leg can feel heavy when there is accompanying weakness SIGNS - what you find (9) - On the straight-leg raise, pain reproduced between 30 and 70 degrees of hip flexion, felt mainly in the back, suggests a lumbar disc herniation [disc herniation] - A positive test at under 70 degrees with pain radiating below the knee, the Lasegue sign, points most to L4, L5, or S1 radiculopathy - Ankle dorsiflexion of the symptomatic leg while raising it (Bragaad sign) increases the test's sensitivity - Popliteal pressure reproducing the same discomfort as the straight-leg raise is a positive Bowstring sign - Coughing that reproduces the pain is a positive Naffziger test [cough] - A crossed straight-leg test positive at 40 degrees on the unaffected side suggests a central disc herniation causing severe irritation of the nerve root [disc herniation] - Hip adduction and knee extension weakness with anteromedial thigh sensory loss localises to L3 [numbness] - Weak ankle dorsiflexion with an absent knee jerk points to L4, while weak hip abduction and big-toe extension point to L5 - Absent ankle jerks are the hallmark of S1 nerve root compression TESTS (4) - Imaging adds little value up front for a clinical diagnosis of sciatica - Plain lumbosacral films can be read for fracture or spondylolisthesis when imaging is needed - Pain persisting 6 to 8 weeks despite conservative treatment should be imaged, with MRI as the modality of choice - A neurological deficit or suspected mass effect warrants immediate MRI to rule out urgent surgical pathology IF NOT THIS - what else fits (7) - Piriformis syndrome, from overuse in runners, worsens with direct muscle pressure, climbing stairs or inclines, and reduced hip range of motion - Freiberg and FAIR manoeuvres help pick out piriformis syndrome as the cause of sciatica-like symptoms - A lateral disc herniation affects the transversing nerve root, while a far-lateral herniation affects the exiting root one level up - In severe L5/S1 spondylolisthesis, central and lateral recess narrowing usually affects the L5 root, while foraminal narrowing affects L4 - Pott disease causes rest pain that is pathognomonic, with radicular pain only rarely the main complaint - Fever, weight or appetite loss, malaise, and fatigue are less common with spinal TB than with pulmonary TB - Spinal TB progresses from brisk reflexes and a Babinski sign to upper motor neuron weakness, then loss of crude touch, pain, and temperature, then sphincter and sensory loss Source StatPearls "Sciatica" - disease-level clinical article Status traced to the source above 1. NAPROXEN [1st line] Adult 500 mg twice daily with or after food x 1-2 weeks Peds Red flag in children - sciatica in a child is not disc disease until proven otherwise (spinal tumour, discitis, spondylolisthesis, slipped upper femoral epiphysis all present this way). Refer urgently; no paediatric dose is given here because this is not a condition to treat symptomatically in primary care. Naproxen is in any case not licensed under 16 years for this indication. Source Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) Why NICE NG59 makes no positive drug recommendation for sciatica - its 2020 pharmacological review found no agent with clinical benefit. An NSAID is offered here as short symptomatic cover while the mainstay is arranged: keep moving, physiotherapy, and referral for persistent or progressive neurological deficit. Caution Contraindicated in active GI bleeding, severe heart failure, or severe renal failure. Co-prescribe PPI in patients >65 years or with history of peptic ulcer disease. Caution in asthma (risk of NSAID-exacerbated respiratory disease). NICE NG59 recommendation 1.2.16 (2020): do not offer gabapentinoids, other antiepileptics, oral corticosteroids or benzodiazepines for sciatica - no evidence of benefit and evidence of harm. Egypt ORGOPROXEN 500 MG 20 TAB. ORGANOPHARMA ... 16.00 EGP (0.80/unit) NAPROSYN 500 MG 10 TAB. MISR > F.HOFF... 8.05 EGP (0.81/unit) NAPROFEN 500MG 10 TAB. EL NILE. 12.00 EGP (1.20/unit) NAPROFEN 500MG 20 TAB. EL NILE. 24.00 EGP (1.20/unit) 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Sciatica - disease-level clinical article (sciatica-full.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Bowel/bladder incontinence, urinary retention, or lower extremity weakness signals acute neurologic deficit requiring aggressive workup (cauda equina). RED FLAG - IV drug use and immunocompromise (HIV, diabetes) raise risk of epidural abscess. RED FLAG - History of trauma, malignancy, or tuberculosis, or fevers/night sweats/chills should prompt work-up for fracture, metastasis, or infection rather than simple sciatica. RED FLAG - Diagnosed spinal mass effect (epidural abscess or hematoma) requires immediate spinal surgeon consultation. 3. PARACETAMOL [add-on - not a substitute] Adult 1000 mg 3-4 times daily as needed (max 4000 mg daily) x 1-2 weeks Peds Red flag in children - sciatica in a child is not disc disease until proven otherwise (spinal tumour, discitis, spondylolisthesis, slipped upper femoral epiphysis all present this way). Refer urgently; no paediatric dose is given here because this is not a condition to treat symptomatically in primary care. Source MSF Essential Drugs 2024 - paracetamol (oral) Why Adjunctive simple analgesic combined with NSAID Caution Do not exceed maximum daily dose (risk of severe hepatotoxicity). Check total daily dose from all paracetamol-containing combination products. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)