FAQ’s on Sciatica Pain & Treatment
Sciatica is pain that results from inflammation of the sciatic nerve, which is a large nerve starting in the low back and going down the back of the leg on each side.
What are the symptoms of sciatica?
Individuals who suffer from sciatica experience significant pain that is often burning or searing in nature. People may also have numbness, tingling or a pins and needles sensation and the pain may be shooting at times like an “electric” feeling. The pain typically affects one side of the body and may also lead to weakness of the leg or foot in addition to numbness.
The area of pain and numbness depends on where exactly the nerve root compression and iinflammation is occurring. If the compression and resulting inflammation of the nerve is severe, a person may have constant debilitating pain. In others, it may be infrequent and simply a slight irritant.
Sciatica pain may also lead to pain in the hip, buttock, and thigh. It is often associated with lower back pain but when it comes to nerve root compression there may be no back pain at all. depending on how bad the pain and weakness are, a person may limp while walking or may need to spend time in bed with a pillow under the knees when it is at its worst.
What causes sciatica?
Sciatica is caused by irritation of nerve roots in the lower lumbar and sacral spine. The sciatic nerve is actually a combination of multiple nerve roots coming together in the lower lumbar and sacral spine. Causes of sciatica may include lumbar spinal stenosis, degenerative disc disease, a disc herniation, spondylolisthesis or pregnancy. All these conditions may lead to a pinched nerve which can cause inflammation of the nerve and sciatica pain.
How common is sciatica?
At any given point in time, approximately 1% of the population is experiencing a disc herniation with sciatica. In addition, there are quite a few other individuals dealing with sciatica pain from the other conditions mentioned. You have to figure that in America there are over 5 million people at any one point in time experiencing sciatica. It is a very common phenomenon.
How is sciatica diagnosed?
A comprehensive history and physical examination is important to figuring out where sciatica is coming from. Typically when a patient lays on his or her back and a physician lifts up the leg while it is straight, sciatica pain will be worse if it is coming from a typical disc herniation.
When the leg is then bent at the knee, the nerve root experiences less tension and the pain lessons. X-rays are typically not very helpful as they do not show the soft tissues such as nerve roots very well. an MRI is typically very helpful as it can show a disk herniation or other soft tissue abnormality that is compressing on a nerve root. If there is concern over muscle weakness, an EMG along with a nerve conduction study can show exactly how bad the nerve has been damaged.
What are the treatments available for sciatica?
One of the most common treatments advocated in the past was for bed rest. However, numerous studies have now shown that bed rest more than 24 to 48 hours can actually cause more problems than it does benefit (Patrick et al, NEJM 1999). So the more modern way of approaching sciatica is to have the patient be as active as possible from the very beginning.
Nonsurgical treatments that are typically helpful for sciatica include chiropractic treatment, physical therapy, spinal decompression therapy and treatment with a pain management doctor at an Arizona pain clinic. The treatments provided by Arizona pain doctors that can help include medication management along with epidural steroid injections.
Medications include Tylenol and anti-inflammatories to start along with muscle relaxers such as Valium. For the short term acute pain, opioid medications may be extremely helpful or a one time burst of prednisone called a Medrol Dosepak can also provide significant pain relief. There are some risks to prescribing a Medrol Dosepak, so it should only be given once every few years. An H2 blocker like Pepcid or some kind of gastric protection should be taken along with it and it should not be combined with additional anti-inflammatory medication as it can lead to an ulcer otherwise.
The gold standard injection treatment for sciatica due to a disc herniation or other nerve root compression is epidural steroid injections. Epidural injections have been performed since the 1950s with overall excellent results. They are typically performed as a series of injections. If one helps somewhat then a second and third injection may provide complete pain relief for individuals.
Injections of steroids around the inflamed nerve root will not fix the nerve root compression. But they can provide a significant anti-inflammatory effect and hence pain relief. The objective is to give the body enough pain relief to avoid surgery while the body itself is disintegrating the offensive soft tissue compressing the nerve root. The body knows the herniated disc is not supposed to be there, so it will typically get rid of that portion over time.
How well do nonsurgical sciatica treatments work?
Approximately 80% of those with sciatica recover from the pain within 6 weeks (Van de Velden et al, Utrecht 1990). Close to 90% will recover within 6 months and be able to avoid surgery, and about 5 to 10% will not recover enough and require surgery (Hakelius A, Acta Orthop Scand 1970).
If you or a loved one is experiencing sciatica with significant symptoms, the board-certified pain management doctors and chiropractors at Arizona pain specialists can help you. They provide non-surgical and minimally invasive treatments including medication management, chiropractic treatment, spinal be compression therapy, Physical rehabilitation and injection treatments. These are over 90% effective at helping patients avoid surgery for sciatica.
However, avoiding surgery does not mean complete recovery or complete satisfaction. Studies have varied on outcomes, but on average somewhere between 50 to 60% of patients end up with a complete recovery after sciatica, meaning that residual symptoms often persist (it may just be some numbness without pain) (Weber, 1983 volvo award).
If you are suffering from sciatica and would like the best chance of avoiding surgery, Arizona Pain Specialists offers comprehensive options with Board Certified pain management doctors and chiropractors. There are clinics throughout the Valley serving Phoenix, Mesa, Chandler, Glendale, Tempe, Scottsdale, Goodyear, Avondale, Surprise, and more.