Doctor's Notes on Sciatica
Sciatica is discomfort or pain because of irritation of the sciatic nerve, usually on one side of the body. Signs and symptoms are discomfort or pain typically felt from the low back to behind the thigh and radiate down below the knee. Pain may get worse with sitting down. Some pains may begin in the hip; others may consist of burning or tingling down the leg. Others may experience weakness, numbness, or problems moving the foot. In addition, some patients experience a constant pain in a buttock, and others may have a shooting pain occur on standing and/or walking.
Sciatica is caused by irritation of one or more nerve bundles of the sciatic nerve that originates in the lumbar spinal cord. A herniated disc can press on the sciatic nerve bundle and cause pain anywhere there are bundles of sciatic nerves. Since the sciatic nerve is the longest nerve in the body, an irritation of part of it at the lower spine can be responsible for pain far removed from the disc that caused the irritation. For example, pain in the lower leg or foot may have its origin in the lower back from a disc that puts pressure on a part of the nerve. Other causes that may contribute to sciatica are adjacent bone (for example, narrowing of the space between bone and nerve), tumors, muscle squeeze of the nerve, internal bleeding, infections, and injury.
What Are the Treatments for Sciatica?
If self-care does not help (rest, avoiding activities that cause sciatic pain, for example), the general treatments may include one or more following methods of treatment, depending on the severity and cause:
- Muscle relaxants
- Tricyclic antidepressants
- Antiseizure drugs
- Narcotics (short-term use; addictive potential)
- Steroid injections near the involved nerve root
- Surgery (for patients with a poor response to medications and/or loss of bowel or bladder control)
- Bone spur removal
- Spinal diskectomy
- Physical therapy: exercises to strengthen back muscles, improve flexibility, and posture when your pain level decreases
Your doctor can help you to design a treatment plan that fits your condition.
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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.