Pain Management and Sciatica
It was a morning like any other for Sarah. She woke up at the first ring of the alarm clock on her bedside table.
As she got up from bed, she felt a sharp pain that started from her lower back, went down through her left buttock and ended somewhere in her thigh.
It felt like a bolt of lightning. It lasted just a few seconds before disappearing. Initially, Sarah did not give it much thought.
Over the course of the day, however, she felt the pain several more times, especially when she moved from a sitting to standing position.
She also felt a tingling sensation in her left leg, and this started worrying her a bit.
When she woke feeling the same way the following morning, she decided to see her doctor.
After performing a physical examination, Sarah’s doctor diagnosed her with Sciatica.
Fortunately for her, her case was not serious, and the doctor only prescribed medicines to take away the pain and advised that the condition would let up on its own.
Sarah is not alone in this. Approximately 1-10% of the population will experience sciatica at least once in their life, with people between the ages of 25 to 45 being more likely to be affected.
The numbers could even be higher since sometimes sciatica is lumped together with back pain or other forms of leg pain.
But what exactly is this sciatica?
WHAT IS SCIATICA
Sciatica is a pain that a person feels when the sciatic nerve is irritated or pressured.
The sciatic nerves are a pair of the largest nerves within the human body.
Each of these nerves is about as thick as your little finger.
Various nerve roots emanating from the lower lumber spine come together on each side of the spine to form the sciatic nerves.
Each sciatic nerve then runs down your lower back, through your pelvis and buttocks and down the back of your upper thigh.
At the back of the knee, the nerve separates into various branches that go down the lower leg and into the feet and the big toes.
Sciatica occurs when a root that joins one of the sciatic nerves is either irritated or pinched.
The pain can be felt anywhere along the sciatic nerve – the lower back, the buttocks, the back of the thigh, the calf or the foot.
Sometimes, the pain might shoot down the entire length of the sciatic nerve, starting in the lower back and ending in the foot.
The pain varies depending on the person and the cause of the sciatica. You might experience a mild ache or a sharp shot of pain like in Sarah’s case.
Sometimes, the pain can be so extreme that you might not even want to get off your bed or couch.
Sciatica can also be accompanied by numbness and a tingling sensation, as well as weakness in the affected leg.
The pain might be exacerbated by sudden movements such as coughing or sneezing, by a change in position, such as when you stand up from a sitting position, or during lifting or twisting movements. Prolonged sitting or standing can also intensify the pain.
Sciatica be either acute or chronic.
Acute sciatica is usually short term, lasting for about a week or two. In most cases, acute sciatica lets up by itself, though your leg might continue feeling numb for a while after the pain has receded.
Some people might experience a couple of sciatic episodes within a year.
Chronic sciatica, on the other hand, is a long-term condition.
A person suffering from chronic sciatica experiences the pain for longer periods of time.
The pain lets up for short durations before starting again.
However, the pain is usually less intense compared to the pain from acute sciatica.
Chronic sciatica is not very responsive to treatment and will usually remain for the rest of a person’s life.
Sciatica is usually characterized by the following symptoms:
- Pain in the lower back
- Hip pain
- Butt or leg pain that intensifies when you sit
- A tingling or burning sensation down your leg
- Numbness and weakness in the leg
- A sharp bolt of pain that radiates down your leg, making it difficult for you to stand or walk
- A persistent pain on one butt
- A pain that intensifies when you stand or sit, but subsides when you are walking or lying down
Pain from sciatica is usually experienced on only one side of the body.
Like I mentioned earlier, the symptoms may become more intense when changing positions or during sudden movements.
WHAT CAUSES SCIATICA
Sciatica can be caused by anything that results in pinching of the sciatic nerve.
Actually, sciatica is not a condition by itself, but rather a symptom of other lower back problems that might be irritating or placing undue pressure on the sciatic nerve.
Some of the common causes of sciatica include:
Lumbar herniated disc: This is by far the most common cause of sciatica, responsible for about 90% of all sciatica cases.
The vertebrae that make up the spine are separated and cushioned by disks of soft, flexible connective tissue.
A lumbar herniated disc occurs when a disc in the lumbar (lower) section of your spine gets worn out, either due to years of use or injury, causing the disk to start pushing outward.
A herniated disk can also be referred to as a bulging disc, a ruptured disc, a protruding disc, or a slipped disc.
The bulging of a disc might pinch the root of the nerves around it.
If the nerve roots happen to connect to the sciatic nerve, this can result in a lot of pain along the sciatic nerve.
Degenerative disc disease: As you grow older, the discs in your spine will experience some level of generation due to tear and wear.
Degeneration of the discs causes excessive micro-motion of the discs. For some people, this results in inflammatory proteins from within the disc getting exposed.
If these happens near the sciatic nerve, these inflammatory proteins can irritate the nerve, leading to sciatica.
Alternatively, degeneration of the discs might lead to development of bone spurs which then end up pressing against the sciatic nerve.
Isthmic spondylolisthesis: This is a condition where one vertebrae slips forward on another due to a small stress fracture.
This shift in the position of one vertebrae relative to the position of the other vertebrae pinches the nerve, resulting in sciatica.
Lumbar spinal stenosis: This is a condition caused by narrowing of the spinal canal. This increases pressure on the sciatic nerve, resulting in sciatica. Lumbar spinal stenosis usually occurs due to aging.
This cause of sciatica is common among people above the age of 60.
Lumbar spinal stenosis is usually caused by overgrowth of soft tissue within the spine or enlarged facet joints. This condition usually occurs alongside spinal arthritis.
Piriformis syndrome: The piriformis is a muscle in your buttock that connects the femur to the sacrum. This muscle is responsible moving your thigh side to side. The sciatic nerve runs under this muscle.
Piriformis syndrome occurs when this muscle is tight or inflamed.
Since the muscle stretches across the sciatic nerve, inflammation or tightness of the muscle may irritate the nerve, leading to sciatica-like pain.
Sacroiliac joint dysfunction: This is a condition where the sacroiliac joint is irritated, which in turns leads to irritation of the L5 nerve, resulting in a pain that feels like sciatica. While the pain resembles sciatica, it is good to note that this is not actual sciatica.
The above are the most common causes of sciatica. However, there are some other factors and conditions that might cause sciatica, though the chances are quite minimal. These include:
Spinal tumor: Tumors in the lower spine can put pressure on the nerve roots that form the sciatic nerve, resulting in sciatica symptoms.
These tumors might have originated from the spine or might have developed as a cancer and spread to the spine from another area of the body.
Scar tissue: This is a condition where a lumbar nerve is compressed by scar tissue, resulting in sciatica.
Pregnancy: Pregnancy causes a number of changes to the body, including weight gain. These changes might shift the body’s center of gravity and cause a misalignment of the spine, leading to sciatica during pregnancy.
Infection: While these seldom occur, they can affect the nerve roots that form the sciatic nerve, leading to pain along the nerve.
Muscle strain: Sometimes, strain in the muscles of the lower back might lead to inflammation, thus putting pressure on the nerve roots of the sciatic nerve.
RISK FACTORS FOR SCIATICA
Age is a significant risk factor for sciatica, with those between the ages of 30 and 60 being most susceptible.
This is because people within this age bracket are the most likely to experience age-related degeneration of the spine.
Sciatica is very rare below the age of 20.
Weight gain is another risk factor for sciatica, since the extra weight puts more pressure on the spine, increasing the risk of suffering from a herniated disk.
Sciatica can also be caused by the nerve damage that is caused diabetes.
Jobs that involve prolonged sitting or heavy lifting also increase the risk of damaged discs and cause sciatica.
Other risk factors include a sedentary lifestyle, sleeping on mattress that is too soft, or wearing high heels.
WHEN TO SEE A DOCTOR
Sciatica is not a serious condition, and in most cases, the symptoms will subside on their own.
However, if your pain is too severe, or does not go away after a few days, you should seek medical attention.
In addition, you should immediately see a doctor if you see any of the following symptoms:
- The symptoms get progressively worse instead of improving.
- Weakness and numbness in the lower leg. This could be an indicator of possible nerve damage.
- Very severe pain in the leg or lower back.
- Bilateral sciatica – this is where the symptoms are experienced on both legs.
- Strange sensations in the genital area accompanied by bladder dysfunction. This could be an indicator of a condition known as cauda equine syndrome. While this condition is relatively rare, it is quite serious and can even lead to paralysis.
- If you started experiencing sciatica after an accident or other trauma.
- If your sciatica is accompanied by other non-sciatica symptoms, such as loss of appetite or fever.
HOW IS SCIATICA DIAGNOSED?
Remember, Sciatica is not a condition in itself, but a symptom of an underlying condition.
Therefore, the doctor will not be diagnosing sciatica, but rather the underlying condition that is causing the sciatica.
If you are experiencing sciatica symptoms, the first thing the doctor will do is ask you questions about the pain you are feeling and about your lifestyle – whether you sit for extended periods of time, whether your job involves a lot of physical work, and whether you exercise regularly.
After the question, the doctor might also need to do a physical examination to identify the nerve that might be causing the problem.
To do this, the doctor might request you to do some exercises – such as lifting the affected leg while lying on your back, walking on your heels or toes, or squatting – and express any time you feel pain.
Sometimes, you doctor might also need to perform imaging tests such as MRIs, CT scans and X-rays, especially when the pain is severe or when the sciatica is chronic.
The aim of these tests is to try and identify herniated discs or bone spurs that might be causing the pain.
EMG tests can also be conducted to find out the nerves that are being compressed.
TREATMENT AND PAIN MANAGEMENT FOR PEOPLE WITH SCIATICA
The fortunate thing about sciatica is that it is not life-threatening in most cases and will usually go away on its own.
However, if the pain persists, there are a number of available treatment options, including:
This is the first treatment option for sciatica, and is used in cases where the pain is not severe but has persisted over a couple of weeks.
In this case, the doctor might request a set of exercises that might help ease the pain.
In most cases, sciatica is caused by weak or overly tight musculature around the spine.
This might be caused by poor posture, a sedentary lifestyle or compromised muscles.
In this case, the doctor will recommend gentle exercises that help strengthen your back and abdomen and improve your posture, thereby reducing the intensity of the pain and reducing the likelihood of sciatica occurring again in future.
Tightness in the areas around the pelvis – the hips, glutes, and hamstrings – might also be putting stress on your lower back and contributing to sciatica.
In this case, the doctor might recommend a stretching routine that increases flexibility around the hips and hamstrings.
This is especially effective in cases where your sciatica has been caused by piriformis syndrome, or in patients who spend extended periods of time in a sitting position.
If you have sciatica, you should only engage in exercise under the guidance of a physical therapist who has experience working with sciatica cases, since some exercises can aggravate the condition.
Working with a specialist also ensures that you perform the exercises in the correct form, since poor form can also exacerbate the condition.
When you have sciatica, you should avoid running and other high-impact exercises.
If the symptoms do not improve after physical therapy, the doctor might prescribe medications to help relieve the pain.
There are various medications that might be recommended for sciatica pain.
The doctor might recommend over-the counter pain relief medications such as ibuprofen, aspirin, acetaminophen, naproxen, or ketoprofen.
Alternatively, anti-inflammatory drugs might be given to ease sciatica in cases where the sciatica is caused by inflammation.
Narcotics have also been used as pain relief medications for sciatica.
If the sciatica is a result of tight muscles and muscle spasms around the pelvic area, muscle relaxants will be given to loosen the muscles.
Sometimes, antidepressants might also be prescribed to relieve sciatica.
In cases where the pain is too severe, the doctor might give you epidural steroid injections, which are meant to help reduce inflammation.
These medications are directly injected into the area around the sciatic nerve near the lower back.
Epidural steroid injections are great for temporary relief, though they work differently for different people.
They might provide relief for as little as one week in some patients, while other patients will experience relief for up to a year.
Even in cases where they are not very effective, they can still provide the patient with enough relief to allow them to undertake other treatment options, such as physical therapy.
If your pain does not let up even after receiving other forms of treatment, your doctor might recommend surgical treatment.
It’s good to note that this is a last resort treatment that is only used on a very small number of sciatica patients.
This treatment is recommended if the sciatica persists for over 3 months despite undergoing other treatment options.
Surgical treatment is also recommended in situations where sciatica has caused cauda equine syndrome.
Sciatica can be treated using one of these two surgical operations:
Diskectomy: This is a procedure whose aim is to remove whatever is putting pressure on the sciatic nerve, whether that is a bone spur, a herniated disc, or any else that might be pressing on the nerve.
In some cases, the surgeon might be forced to remove the entire disk in order to release the pressure on the nerve.
A discectomy is not a very complex operation. Patients are usually allowed to go home the same day after the completion of the operation.
Laminectomy: The aim of this operation is to remove the lamina and any tissue that might be compressing the sciatic nerve.
The lamina forms part of the ring of bone that surrounds the spinal cord.
After a laminectomy, the patient may be allowed to go home the following day, and will be instructed to wait for a day or two before starting to walk around.
Sciatica Pain Relief Using Alternative Remedies
Aside from the above conventional treatment options, there are other alternative remedies that might also be used to provide relief from sciatica pain.
The most common of these is the use of hot and cold packs.
With this treatment, you should place cold packs on your lower back for several minutes each day for a few days, and then switch to hot packs.
Biofeedback has also been used as a treatment for sciatica.
This is a technique that uses a machines and sensors to provide you with information about different bodily processes.
Once you have feedback from these processes, you can then attempt to control them at will.
Learning how to consciously control bodily processes allows a patient to voluntarily control muscle tension that might be contributing to sciatica.
Acupuncture is another alternative remedy that has is also used to treat sciatica.
According to this therapy, illnesses develop in the body due to blockage of the body’s energy force (chi).
By inserting needles into specific points within the skin, acupuncturists believe they can release this energy, restore the body’s balance and cure illnesses resulting from the blockage.
Massage has also been found to be effective in relieving sciatica pain.
We saw earlier that sciatica might be caused by tensions in the muscles around the pelvic region.
Massage can help loosen these muscles and release the tension, thereby reducing the intensity of sciatica pain.
Sciatica is a condition characterized by pain in the lower back, upper leg, and sometimes lower leg.
Sciatica pain can be so debilitating to the extent of making it impossible for you to perform your daily tasks.
Fortunately, sciatica is not life threatening and can be treated using a variety of home and medical treatments.
However, if you notice your symptoms getting worse, if your experience sciatica on both legs, or if your sciatica is accompanied by loss of appetite, fever, or loss of bowel control, you should seek medical attention immediately.
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