Sciatica

Pain radiating from the lower back or buttock down the leg along the sciatic nerve path — usually from a disc pressing on a nerve root. Most episodes improve substantially over 6-12 weeks with staying active, but the pattern of red flags determines who needs urgent assessment.

Evidence synthesis: Disc herniation compressing a nerve root causes most sciatica, and natural-history studies show most herniations resorb over months — explaining why 6-12 week improvement is the rule. Guidelines consistently recommend staying active and avoiding bed rest, with evidence that prolonged rest worsens outcomes; structured exercise and physiotherapy have moderate trial support. Imaging is deliberately deferred in guidelines because disc bulges are common in pain-free people and early MRI does not improve outcomes. For neuropathic leg pain, pregabalin and gabapentin are commonly used though trial results in sciatica specifically are mixed (a notable pregabalin RCT in sciatica was negative). Alpha-lipoic acid has positive neuropathic pain trials in diabetic neuropathy and small preliminary studies in radicular pain, but evidence for sciatica per se is early-stage. Cauda equina syndrome — bladder/bowel dysfunction, saddle anaesthesia, bilateral weakness — is the emergency requiring same-day surgical assessment.