Sciatica

General

Sciatica (pronounced sigh-AT-ih-ka) pain is one of the most prevalent and annoying pain conditions prompting one to seek the care of a pain physician. The sciatic nerves are the largest nerves in the body, about the diameter of your little finger. Branches of several smaller nerves that exit the spine of the lower back join together to form the sciatic nerve. There is one sciatic nerve on each side of the spine that travels into the corresponding gluteal region and down the leg to the foot. Pain that radiates from your lower back, also called the lumbar spine, to your buttock and down the back of your leg is the hallmark of sciatica. You may feel the discomfort almost anywhere along the nerve pathway, but it is especially likely to follow a path from your lower back to your buttock and the back of your thigh and calf and sometimes all the way to the foot.

Symptoms

Sciatic pain can vary widely, from a mild ache, to pins and needles, to a burning fire sensation or to an excruciating and intolerable pain. Sometimes it may feel like a jolt or electric shock. It may be worse when you cough or sneeze, and prolonged sitting can aggravate symptoms. Usually only one side of your body is affected, which can help to differentiate sciatic nerve pain from other types of back problems than affect both legs.

Some people also experience numbness, tingling or muscle weakness in the affected leg or foot. You may have pain in one part of your leg and numbness in another. It is also possible to experience lower back pain with a cramping feeling in either the back of the thigh or calf area.

You can test yourself for weakness that may be resulting from sciatica by trying to walk across the room on your heels. If you cannot hold up the affected foot, then weakness is indicated in the anterior lower leg musculature. You can also attempt to walk across the room on your toes only. If you cannot make it across the room on toes, then calf muscles have weakened as a result. If you have weakness or visible loss of muscle girth when you compare the diameter of your affected lower leg to the opposite leg, then you have already waited longer than you should have to call Novocur for help.

Complications

Although most people recover fully from sciatica, often without any specific treatment, sciatica can potentially cause permanent nerve damage. Seek immediate medical attention if you experience:

  • Loss of feeling in the affected leg
  • Weakness in the affected leg
  • Loss of bowel or bladder function (this is a 9-1-1 situation)
Causes

Irritation of the sciatic nerve is the cause of your pain. Irritation often results from disc bulging or herniation that applies pressure to one or more of the nerve roots that exit the lumbar spine and join together to form the sciatic nerve. Bony spurring or nerve root canal narrowing that develops as a result of degenerative arthritic changes to the spine can also be a culprit. Often a combination of the two is most likely.

Sciatic pain can also occur as a result of compression irritation of the sciatic nerve as it travels through tight gluteal musculature. Rarely, the sciatic nerve penetrates through gluteal musculature, as an anatomical variant, instead of passing between muscle layers. Whenever the penetrated muscle contracts, it squeezes the sciatic nerve and causes pain.

Treatments

  • Physical Therapy. Often advised to strengthen the core to help stabilize the lumbar spine. Lower extremity strengthening and flexibility may be needed in chronic cases too. Frequently, very acute pain prevents physical therapy or chiropractic care from taking place until Pain Management options bring the pain down to levels that enable therapy to take place.
  • Pharmacological Intervention. NSAIDs, tricyclic anti-depressants, neuropathic pain medications and narcotic pain medications are options. Medications are usually aimed at symptoms and not underlying causes, but can help manage the pain while effective long term options are evaluated and attempted.
  • Pain Management Interventions.
    • Transforaminal Epidural Injection. Probably one of the most effective treatments that can very quickly reduce the inflammation directly at the site of the problem. This requires the skill of a fellowship trained pain physician to accomplish with the help of special imaging equipment. A corticosteroid and local anesthetic mixture are injected around the affected nerve root or roots as they exit the spinal cord, pass behind spinal discs and travel through the bony exits of the spinal column.
    • Trigger Point Injection. An injection of an anti-inflammatory medication mixed with a local anesthetic may be injected into tight musculature that irritates the sciatic nerve. Injection accuracy is often accomplished through the use of diagnostic ultrasound equipment during this procedure.
    • Dry Needling. Sometimes, the doctor may use a technique called “dry needling”, which involves no medication, but helps to break up trigger points within a tight muscle bundle to help relax the tissue around the nerve.
    • Neuromodulation Therapy. This last resort option is often utilized following surgical interventions that have failed to control the pain. Thin electrodes are placed into the epidural space overlying the spine. A generator, similar in technology and size to a pacemaker, bathes the affected nerve tissue with small electrical current. This treatment has the effect of replacing excruciating pain with a pleasant buzzing sensation. In essence, the nervous system is tricked into feeling a different sensation than pain.

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