Have a patient complaining of low back pain that radiates down the leg? Do you suspect a discogenic etiology? You need to ensure you treat them with an appropriate anti-inflammatory regimen.
Too many providers are trigger happy to just prescribe patients with sciatica 800mg ibuprofen as needed or a Medrol dose pack (this is not strong enough). This often times results in subpar results for the patient.
The goal is to reduce the inflammation around the compressing lesion (herniated disc) on the nerve. Patients need a prolonged course of anti-inflammatory treatment to accomplish this.
My go to regimen is either naproxen (500mg BID) or meloxicam (15mg daily) for 2 weeks. If I feel like the sciatica/lumbar radiculopathy is severe, I will use prednisone 50mg x 5 days and then bridge the anti-inflammatory effect with 1 week of naproxen or meloxicam after they are done with the steroid.
This regimen works well for patients with lumbar radiculopathy. Sometimes, the symptoms will resolve totally and not return. I have personally experienced it! I have a herniated disc with nerve impingement at L4-L5…
Remember though, if they have a history of acid reflux, make sure to also put them on 20mg omeprazole daily during this regimen to prevent an increase in the acid reflux and peptic ulcers!