STUDY DESIGN.: Longitudinal qualitative interview study, nested within a back pain cohort study. OBJECTIVE.: Enhance the understanding of patients' own perspectives on living with sciatica to inform improvements in care and treatment outcomes. SUMMARY OF BACKGROUND DATA.: Reports of patients' own accounts of sciatica and its impact on daily life are still scarce. Research on back pain has shown that it is important to understand how people live with pain and how they perceive interactions with health care professionals and interpret interventions. These types of insights help to improve treatments and their acceptability to patients. METHODS.: In-depth qualitative interviews with 37 people at baseline and 6 and 12 months' follow-up. The interviews covered topics that were derived from the Illness Perceptions Questionnaire and allowed open-ended talk about people's experiences of pain. All interviews were tape-recorded, fully transcribed, and thematically analyzed. RESULTS.: People needed to make sense of sciatica through identifying a cause and having it clinically diagnosed. The impact of sciatic pain was seen to be constant, intense, and all-encompassing. Appreciation of this by clinicians was considered important, as well as the provision of clear information about treatment and prognosis. Expectations about treatment options varied between patients, and people balanced pain relief with adverse effects. CONCLUSION.: Our study highlights patients' own accounts of the distinctiveness, impact, and intrusiveness of their sciatic symptoms. Our findings emphasize the importance of leg pain in identifying a subgroup of back-pain patients more likely to have severe symptoms, be at risk of poor outcome, and who should be considered a priority for early diagnosis and management. Future management of sciatica needs to include listening to patients' stories, offering a credible physical assessment, explanation, and diagnosis of the condition. Explaining the limits to treatment is seen as positively contributing to the partnership between patients and clinicians.