more than 75% of sciatica cases are managed without surgery. in persons that smoke who also have sciatica, smoking cessation should be strongly considered, in order to promote healing. treatment of the underlying cause of nerve compression is needed in cases of epidural abscess, epidural tumors, and cauda equina syndrome. physical activity physical activity is often recommended for the conservative management of sciatica for persons who are physically able. however, the difference in outcomes between physical activity compared to bed rest have not been fully elucidated. the evidence for physical therapy in sciatica is unclear though such programs appear safe. physical therapy is commonly used. nerve mobilization techniques for sciatic nerve is supported by tentative evidence. medication there is no one medication regimen used to treat sciatica. evidence supporting the use of opioids and muscle relaxants is poor. low-quality evidence indicates that nsaids do not appear to improve immediate pain, and all nsaids appear to be nearly equivalent in their ability to relieve sciatica. nevertheless, nsaids are commonly recommended as a first-line treatment for sciatica. in those with sciatica due to piriformis syndrome, botulinum toxin injections may improve pain and function. while there is little evidence supporting the use of epidural or systemic steroids, systemic steroids may be offered to individuals with confirmed disc herniation if there is a contraindication to nsaid use. low-quality evidence supports the use of gabapentin for acute pain relief in those with chronic sciatica. anticonvulsants and biologics have not been shown to improve acute or chronic sciatica. antidepressants have demonstrated some efficacy in treating chronic sciatica, and may be offered to individuals who are not amenable to nsaids or who have failed nsaid therapy. surgery if sciatica is caused by a herniated disc, the disc's partial or complete removal, known as a discectomy, has tentative evidence of benefit in the short term. if the cause is spondylolisthesis or spinal stenosis, surgery appears to provide pain relief for up to two years. alternative medicine low to moderate-quality evidence suggests that spinal manipulation is an effective treatment for acute sciatica. for chronic sciatica, the evidence supporting spinal manipulation as treatment is poor. spinal manipulation has been found generally safe for the treatment of disc-related pain; however, case reports have found an association with cauda equina syndrome, and it is contraindicated when there are progressive neurological deficits. prognosis about 39% to 50% of people with sciatica still have symptoms after one to four years. in one study, around 20% were unable to work at their one-year followup, and 10% had had surgery for the condition. epidemiology depending on how it is defined, less than 1% to 40% of people have sciatica at some point in time. sciatica is most common between the ages of 40 and 59, and men are more frequently affected than women.