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.
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
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.