Sciatica
Sciatica is a condition that refers to a group of pain symptoms or unusual sensations, typically manifesting on one side of the body, lasting for a period of weeks to months.
The pain and other sensations result from an irritation or compression of one or more nerve roots in the lumbar spine, or lower back. Pain often starts in the lower back or in the buttocks, down the leg, the ankle, and into the foot.
The symptoms range from pain, cramping, weakness, tingling, or numbness. Sometimes the pain is described as a having a “pins and needles” sensation. The discomfort follows the same pathway as the sciatic nerve—down the leg.
Most patients fully recover from sciatica; and in most cases, the nerve is not permanently damaged. Although not typically considered an emergency, medical attention is needed if the symptoms are severe and don’t improve. If more serious symptoms arise, consult your physician, or go to the emergency room immediately.
Serious symptoms may include:
- Severe pain
- High body temperature
- Bladder or bowel incontinence
- Lower extremity weakness
- Profound loss of sensation
- Inability or difficulty in walking
The sciatic nerve is the longest and largest nerve in the body. It controls motor and sensory functions for the lower extremities (legs, ankles and feet). As such, the sciatic nerve can be compromised by a variety of conditions and diseases. Many of these conditions can ultimately lead the nerve to become inflamed, pinched, stretched or damaged.
Conditions that cause lower back pain and sciatica include:
- Herniated or bulging disc
- Degenerative disc disease
- Spinal stenosis
- Piriformis syndrome
- Facet hypertrophy
Additionally, sciatica and lower-back pain may also result from pregnancy, tumor, pelvic infections, and other causes.
To diagnose this condition, a pain physician performs various muscle tests to note any limitations in movement in the lower extremities. The pain physician most likely will order one or more diagnostic tests, such as X-ray, Computerized tomography (CT) scan, Magnetic resonance imaging (MRI) or bone scan. MRIs are considered the best procedure to detect causes of chronic lower-back pain and sciatica. Depending on medical history and other factors, additional tests may be required.
There are many treatment options available for pain relief, reduction and management.
Pharmacotherapy – over-the-counter non-steroidal anti-inflammatories (NSAIDs), acetaminophen and other analgesics. Prescription medications such as, membrane stabilizing drugs and muscle relaxants may be prescribed for pain relief or management associated with lower-back pain and sciatica.
Epidural steroid injections (ESI) – this procedure involves injecting a medication into the epidural space. The injection includes both a long-lasting corticosteroid and a local anesthetic. The corticosteroid is long-lasting and works to reduce inflammation and irritation. The anesthetic works immediately to interrupt the pain-spasm cycle.
Lysis of adhesions – also know as the “Racz Procedure.” Using an epidural needle, a catheter is placed into the injection site to administer fluids and medication, during the procedure, and to break-up scar tissue.
Trigger point injections (TPIs) – this involves injecting a local anesthetic and corticosteroid into one or more trigger points. TPI addresses areas of muscle containing trigger points, such as knots of muscle formed through muscles spasms.
Disc decompression – a needle is inserted through the skin into the herniated or bulging disc with a local anesthetic and possible sedative. The protruding material is suctioned out of the disc and pressure on the nerves or ligaments are eliminated.
Infusions techniques– a local anesthetic and other medicines are administered through the catheter for extended time periods.
Transcutaneous Electrical Stimulation (TENs) – TENs is the use of electric current produced by a device to stimulate the nerves for pain management.
Spinal Cord Stimulation (SCS) – a small electrical pulse generator is implanted under the skin. A low-voltage electrical current is administered and decreases the perception of pain by confusing the spinal cord and brain pain processing centers. This is done on a trial basis.
Intrathecal Pump Implants – an intrathecal pump is a computerized device, which delivers concentrated amounts of medication(s) into the spinal cord area via a small catheter.
Botox injections – injections of small amounts of Botox ease pain through paralyzing nerves or muscles. They should only be administered by a licensed physician, with experience using Botox as a pain relief treatment.
Other alternative and supplemental therapies for sciatica pain relief include, massage, acupuncture, biofeedback, physical therapy and exercise.
Nutrition and healthy eating habits offer many benefits for pain and overall good health. A nutritionist may prescribe a specific nutritional program. This may include the addition of vitamins, minerals, or supplements.
References
- Sciatica – PainDoctor.com
- Rheumatology (Oxford). 2005 Nov;44(11):1399-406. Epub 2005 Jul 19 Arden NK, Price C, Reading I, Stubbing J, Hazelgrove J, Dunne C, Michel M, Rogers P, Cooper C; WEST Study Group. Rheumatology (Oxford). 2005 Nov;44(11):1399-406. Epub 2005 Jul 19 PMID: 16030082
- Interventional Techniques: Evidence-based Practice Guidelines in the Management of Chronic Spinal Pain. Boswell et. All. Pain Physician 2007; 10:7-111