Q: I am suffering from sciatica. Tylenol and ibuprofen help a little bit, but not enough. I have been to a chiropractor, also but still don’t have sufficient relief. Please help.
A: The sciatic nerve is the largest nerve in the body. The condition known as sciatica commonly occurs when a bone spur, pelvic fracture or herniated disc compresses a portion of the sciatic nerve that branches from the lower back and continues down one or both legs. The condition typically affects one side of the body only. In rare instances, the sciatic nerve may be damaged by diabetes or a tumor.
Those individuals at an increased risk for sciatica include being diagnosed with diabetes, obesity, age, and leading a sedentary lifestyle. In the instance of diabetes, the risk of nerve damage is elevated because of the way the body uses blood sugar. Obesity is known to increase the stress and pressure placed on the spine. The aging process may lead to a herniated disc or other conditions that can aggravate the sciatic nerve. And lastly, a sedentary lifestyle that may include sitting for extended periods of time may be contributory. Complications may include a loss of bladder or bowel function, a weakened leg, or diminished feelings in the affected leg. Symptoms that may range from mild to severe may include inflammation, pain, and numbness. While one individual may be bothered by pain and weakness, another may experience less severe symptoms that respond well to conservative treatment such as rest.
Diagnosis may require medical imaging that includes an X-ray of the spine, an MRI or CT. The X-ray may reveal a bone spur that has the potential to press into a nerve. The MRI may show herniated discs and nerves, so it is good in demonstrating nerve compression. A CT is less helpful for diagnosing sciatica but is very good in revealing the specifics of spine disease.
On the home front, cold packs may be used for relief following an attack. If they fail to provide any relief, hot packs may be used, or alternating cold and hot packs may do the trick. Over the counter ibuprofen may also be considered.
Since you have already attempted to find relief through over-the-counter anti-inflammatories, your next step may be in the form of prescription narcotics, perhaps coupled with anti-seizure drugs or tricyclic anti-depressants. Or, corticosteroids injected into the area near the nerve foot may diminish the pain by suppressing inflammation around the nerve. While the steroid may reduce the pain experienced, it will not be a permanent solution and may have to be repeated. However, and as I have stated previously in other columns, the risk of serious side effects must be avoided so repeat injections are recommended very sparingly. Lastly, when conservative treatment fails to diminish the symptoms present, surgery may be considered.
Discuss all your options with your physician who will be your best source of information for how best to help you. Ask if physical therapy that will include stretching exercises might help and be sure to ask about chiropractic manipulation or even acupuncture.
