1. What is sciatica?
2. What are symptoms of sciatica?
- Sharp, burning, stinging, shooting, electric shock or cramps like pain in one or both legs often as far down as the foot. Movement, coughing and sneezing can intensify the pain
- Tingling, pins and needles and/or numbness in leg or foot
- Muscle weakness with difficulty in weight bearing or walking.
- Buttock/low back pain and stiffness.
3. What causes sciatica?
- Disc herniation: Spine is formed of many bones called vertebrae arranged one above the other. In between these vertebrae are discs, which are like cushions or shock absorbers. The discs are made up of an outer tough substance and an inner soft jelly like substance. Herniation of the disc can occur if there is splitting or crack in the outer layers allowing the inner jelly like substance to protrude through the crack. This can cause inflammation and compression of the nerve roots in the vertebral column. Slipped disc is a commonly used term for this condition. There is an increased susceptibility to disc herniation as we age because the soft, jelly like substance dries out and shrinks with time, making the disc more fragile.
- Spinal stenosis: Stenosis means narrowing. The narrowing can be of the central canal of the spine or the passageways/ tunnels from which the nerves exit the spine. Besides disc problems, arthritis of the spinal joints or thickening of ligaments can also cause/ contribute to the narrowing.
- Spondylolisthesis: In this condition there is a problem with the alignment of vertebrae, where one vertebra is more forward or backwards, which can narrow the spaces for nerves and produce sciatica as a result.
- Piriformis syndrome: In this condition piriformis muscle in the pelvis is responsible for pressure on sciatic nerve.
- Trauma/ fractures
- Spinal tumors and infections are rare causes of sciatica
4. Can it resolve on its own?
5. What are the warning signs I need to be watch for?
- Loss of urinary control/ inability to pass urine
- Loss of control over stools
- Numbness around the bottom
- Worsening leg weakness / loss of control
6. What can I do to reduce my risk of having sciatica?
- Giving up smoking
- Regular exercises
- Right posture and work ergonomics
- Healthy diet and maintaining weight in the normal range
- Using proper manual handling techniques while lifting to avoid back injury
- Stress Management
7. What investigations are generally considered for sciatica?
8. What are the other treatment options?
Pain reduction achieved by medicines help to maintain activity and improves physiotherapy compliance. The medications used depend on the type and severity of pain, duration of symptoms and individual factors such as co morbidities and allergies. Some of the commonly prescribed pain killers include
- Non steroidal anti-inflammatory drugs (NSAIDs)
This includes drugs such as DIclofenac, Naproxen, Aceclofenac, Ibuprofen etc. NSAIDs are prescribed to reduce the pain and inflammation during periods of acute sciatica although the evidence supporting their use is not very robust. The risk benefit ratio needs to be evaluated while prescribing any drugs.
- Neuropathic pain killers
This group includes antidepressants and anticonvulsants both of which are well known painkillers for nerve pain. It generally takes a few weeks for the full effects of these drugs to become apparent. Effects such as reduced anxiety and sedation can be used beneficially by tailored selection to suit individual patients. Their use is supported by the NICE guidelines, UK.
Weak opioids such as tramadol are often prescribed during pain flare up episodes. It is a good practice to be aware of the side effects of a medicine prior to using it.
- Muscle relaxants
These are used for short duration to relieve any muscle spasm contributing to the back pain.
Dr. Amod Manocha is a Senior Consultant and Head of Pain Management Services at Max Multispecialty Hospital, Saket. He is trained as a Pain Management Specialist and an Anaesthetist in the UK. He has over 13 years of work experience in the UK including working as a Chronic Pain Consultant in many UK hospitals.