Sciatica Treatment

Sciatica is severe leg pain which is usually caused by a disc protrusion from one of the lower lumbar intervertebral discs. It is also known as nerve root pain as the anatomical part of the nerve which is affected is called the root.

Sciatica symptoms vary in presentation but severe pain below the knee and/or in the foot is a typical presentation, with the pain described in a specific area quite precisely. The pain may be surging and is always very unpleasant, limiting the person's function greatly.

Sciatica pain is uncommon while referred leg pain from spinal problems is very common, with sciatica occurring in around five percent of back pain cases. Lower back pain or lumbago may or may not be present in cases of sciatica.

Further information can be found at NHS Choices and Wikipedia's Sciatica page.

Acute Sciatica

Sciatica often starts with a sudden onset of severe leg pain. One minute everything is OK and the next the leg hurts so severely that the person just has to rest and wonders what could have happened to make things so bad. Sciatica may occur spontaneously in various conditions such as as sciatica - pregnancy.

Sciatica Treatments - Acute Sciatica

1. Due to the presumed inflammation and compression of the nerve, it is reasonable to rest for a period of up to two weeks if the pain is severe enough. You should avoid worsening the pain greatly and choose comfortable positions. At two weeks you should try to get going if you have not been able to up until then as further resting may be counterproductive. However you should get going back to normal activities gradually at any point if you feel you can do so, the earlier the better.

2. Take painkillers as advised by your doctor or pharmacist. Paracetamol and anti-inflammatory drugs such as ibuprofen are often recommended but there are cautions and you should find these out before taking them. Codeine and diazepam are also used but medical advice is required. Take the medication regularly by time and do not take less when you feel less pain and more when you feel more pain. Don't try and give up the painkillers too soon.

3. Remain as active as you can without severe worsening of your pain. Some increase in pain during activities is OK provided you can cope.

4. Pace your activities strictly so that you are doing an activity for a pre-decided number of minutes every hour for example, such as walking about. Increase the amounts slowly as you can.

5. Be positive as although your pain is severe, it is not due to a serious cause and well settle and disappear with time.

6. Ice packs applied to the low back or buttock may ease the pain for some people. 10 minutes is enough at any one time, but cooling will not reach the depth in the body where the disc prolapse is so direct reduction of nerve inflammation is not achieved by this method. Heat packs may be preferable for other people.

7. Walk about regularly if you can.

8. Return to work as soon as you feel able, do not expect to be pain free at this time, that may take longer.

9. Piriformis, a small muscle in the buttock, can be involved in sciatic pain as the nerve may pass under or through it. Piriformis stretches may be helpful in sciatic pain relief.

10. Sciatica stretches as such are often mentioned but stretching the sciatic nerve during the acute period may only increase the pain in the leg so mobilising movements are more appropriate. A physio can guide you on this.

Sciatica pains may take up to six weeks to begin to settle in some cases but are often faster than this. You should monitor your symptoms and if you feel your foot muscles becoming weaker or that you have problems with you bladder or bowel control you should consult your medical adviser at once.

Nerve Root Blocks for Sciatica

Prior to any decision about surgery, a nerve root injection or nerve root block may be suggested. This involves placing painkilling and anti-inflammatory medication around the nerve root where the compression and inflammation are situated. This treatment can give sciatica relief and kickstart the improvement of the pain needed for a person to get going again.

Surgery for Sciatica

If the pain is unreasonably severe, lasts longer than six weeks or so, does not respond to a block or there are increasing neurological changes then a spinal surgeon may decide to remove the disc prolapse via microdiscectomy (smaller incision, quicker recovery) or standard discectomy.

In discectomy only a small part of the disc (the protruding bit) is removed, although the surgeon does check for loose pieces which might come out later. If the disc is very severely degenerated then a fusion of that level may be considered.

Treatment for Sciatica - Chronic Sciatica

Sciatica can become chronic in difficult cases and sometimes even after surgery to decompress the nerve affected. Surgery for chronic sciatica has a lower chance of being successful than for acute sciatica. A sciatica cure would be less likely for this type of leg pain.

Painkillers are useful for chronic sciatica but because the cause of the pain may be due to the altered way the nerve in the damaged area is working the drugs are often different. Normal painkillers may be less effective than in acute sciatica.

Doctors may prescribe antidepressants for their pain relieving qualities, gabapentin (originally for epilepsy), amitriptyline (originally for depression) and pregabalin (known as Lyrica). There are significant side effects with these drugs so will need to discuss this with your doctor. If you have problems it is usually important not to just suddenly stop these drugs and this may make you feel worse – discuss this with your doctor so he or she can plan your management.

Continue to be normally active and maintain your work as you can. A physio can arrange exercises for sciatica and also an exercise programme for you to maintain your general and back fitness as well as using other techniques such as joint mobilisations or piriformis treatment and stretches.

As in other cases of chronic pain where the symptoms are likely to continue into the future, cognitive behavioural therapy or CBT has been found to be useful is maintain mood levels, keeping up normal activity and work and adhering to an exercise programme. With some people CBT may reduce perceived pain levels.

Further information can be found as sciatica emedicine sites such as Emedicine.com.