US Pharm. 2019;44(1):13-14.
Pain Radiating Along the Sciatic Nerve
Sciatica is a common form of back and leg pain that results from compression of the sciatic nerve, a large nerve that runs from the lower spine behind the hip joint and down the back of each leg. It is usually easy to diagnose sciatica because the characteristic pain is a sharp, burning, or stabbing sensation that begins in the lower back and runs all the way down one leg, even into the foot. In severe cases of sciatica, there may be weakness or difficulty standing or moving the affected limb. Although it is a painful condition, sciatica rarely causes any permanent damage to the sciatic nerve.
Sciatica Caused by Spinal Disc Disorders
Sciatica can come on suddenly or develop slowly over time, and the pain can be aching or sudden, sharp, and radiating. In most cases, the pain of sciatica is unilateral, which means that it occurs on one side only. Sciatica pain is caused by an inflammation of the sciatic nerve, usually due to a condition that causes direct pressure on the nerve. The most common cause is a slipped disc in the spine, also referred to as a herniated or ruptured disc. A disc is a cushion of cartilage between each of the bones in the spine, which acts to absorb the shock of movement and maintain spinal flexibility. If part of the jelly-like disc leaks from its capsule, it puts pressure on the sciatic nerve and leads to inflammation and pain.
Sciatica can also result from degenerative disc disease (the cushioning discs in the spine become brittle and break down), spondylolisthesis (one vertebra slips over another), bone spurs (growths that jut out of the bony joints of the spine), or lumbar spinal stenosis (the spinal canal becomes narrowed). Risk factors for sciatica include older age; a family history of back problems; pregnancy or being overweight; sitting or standing for long periods; jobs that require long periods of sitting, bending, or lifting; and sleeping on a soft mattress.
Diagnostic and Treatment Options
To diagnose the cause of sciatic pain, the physician may order imaging tests, such as an MRI, CT scan, or x-ray. An MRI can show the alignment of vertebral discs, ligaments, and muscles. A CT scan using contrast dye can provide a picture of the spinal cord and the nerves. X-rays are used to identify bony abnormalities, but they cannot detect issues with the nerves, muscles, or ligaments. The results of diagnostic tests can help determine the best treatment approach and whether more advanced therapy, such as surgical intervention, is warranted.
The primary goal of immediate sciatica treatment is to reduce pain and inflammation. Conservative treatment with alternating ice and heat packs, stretching exercises, and OTC anti-inflammatory and pain medication is typically the first line of therapy. For more severe or debilitating sciatica pain, a physician may directly inject corticosteroids into the inflamed area. Additionally, the doctor may prescribe muscle relaxants, such as cyclobenzaprine, to relieve the discomfort associated with muscle spasms. The National Institute of Arthritis and Musculoskeletal and Skin Diseases estimates that pain and inflammation will subside with conservative treatment for about 90% to 100% of people within 6 weeks.
Role of Chiropractors
Once the acute pain of sciatica is controlled, physical therapy and chiropractic care can help with treatment and prevent future episodes. Physical therapists and chiropractors use spinal adjustments, exercises, and stretches to correct spinal misalignments, reduce pressure on the discs, nerves, and joints, and improve strength and movement of the spine.
If sciatica is due to a herniated disk, and it still causes severe pain after 6 weeks, surgery may be an option. The surgeon may remove a portion of the herniated disc to relieve the pressure on the sciatic nerve. Other surgical procedures can relieve sciatica caused by spinal stenosis.
If you have questions about sciatica pain or OTC and prescription medications, seek out your local pharmacist or other healthcare practitioner.
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