Sciatica (Sciatic Nerve Pain)

Definition

Sciatica is a condition where there is pain along the course of the sciatic nerve. The sciatic nerve runs from the lower portion of the spinal cord to the back of the thighs and down the lower limbs below the knees. If the nerve gets compressed or damaged somewhere along its course, it results in a pain. Thus, sciatica is just a symptom and not a disorder. In people suffering from sciatica, the pain radiates from the buttocks to the legs.

Symptoms

The hallmark symptom of sciatica is radiating pain, which originates from the lower spine and spreads to the buttock and down the calves.

  • Sharp, stabbing or burning pain
  • Discomfort in the buttock, thighs and/or calf
  • Pain worsening upon coughing or sneezing
  • Prolonged sitting increases the pain
  • Pain usually one sides
  • Numbness or muscle weakness in the leg or foot
  • Tingling in toes or parts of the foot
  • Loss of bladder or bowel control (indicating cauda equina syndrome)
  • Pain radiating down the affected leg upon lifting the unaffected leg

Causes

Compression or injury of the sciatic nerve, either at its root where it emanates from the spine, or along its course across the buttock and down the lower limb is the reason for sciatica. The causes of sciatica can be grouped as follows:

  • Age-related wear and tear
  • Herniated disc in the lower back
  • Narrowed spinal canal (spinal stenosis), especially in the lumbar region
  • Dislocation of a vertebra (spondylolisthesis)
  • Neuromuscular disorder called piriformis syndrome, in which piriformis muscle irritates sciatic nerve
  • Tumors or abscesses inside the spinal cord, within the membranes covering the spinal cord, or in the space between the vertebrae and the spinal cord
  • Trauma to the spine, which injures the nerve roots in lumbar or sacral regions

Treatment

Majority of the people with sciatica respond well to self-care measures and the pain goes away on its own.

Treatment options include the following:

  • Self-care measures: Using cold packs and hot packs alternatively, bed rest, keeping head of the bed higher, and applying over-the-counter (OTC) medications (like, acetaminophen). Stretching and exercising also help in providing relief from sciatica in many cases.
  • Physical therapy: Physical therapy includes rehabilitation program to help in recovery. The therapy focuses on maintaining proper posture, strengthening the muscles supporting the back and improving the flexibility.
  • Medication:
    – Anti-inflammatory drug (like, ibuprofen or aspirin) and a muscle relaxant are often recommended to patients.
    – Narcotics provide short-term relief from pain.
    – Anticonvulsant drugs (like, gabapentin) and tricyclic antidepressants are given to patients with chronic pain.
    – Corticosteroid injections may help in suppressing inflammation and relieving pain. These injections are, however, reserved for severe cases.
  • Surgery:
    – Surgical procedures are reserved for following cases in treatment-resistant cases, for progressive cases or for patients showing weakness or loss of bowel or bladder control.
    – In discectomy, a portion of a herniated disc is taken out, which removes the compression on the sciatic nerve.
    – In a similar and minimally invasive procedure called microdiscectomy, a portion of the herniated disc is removed with the help of a surgical instrument or laser while using an operating microscope. Recovery period is shorter in microdiscectomy, compared to conventional discectomy.

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