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MEDICALCONDITIONSEXPLAINED

AllyouneedtoknowaboutSciaticaThisleafletisintendedforthepatientstohelpthemunderstandtheirconditionandtakeanactiveroleinthedecisionmakingprocess.Iwouldlovetohearfromyou.Pleasefeelfreetoemailanysuggestionsforimprovementtoinfo@removemypain.com

1.Whatissciatica?

Sciaticaistermusedtodescribepainthattravels(radiates)downthelegfromthelowerbackorbuttock.Itisatypeofnervepainandanumberofcasesarecausedbypressureonthenervesduetodiscbulgeinthelowback.Thisismostcommonlyseeninmiddle-agedadultsandmenaremoresusceptible.Thetermsciaticaoriginatedfromthesciaticnerve,whichisthesinglelargestnerveinourbody.Thisnerveisresponsibleforasignificantproportionoflegsensationandmovement.Sciaticarepresentspainintheareasuppliedbythesciaticnerve.

Radicularpain/radiculopathyaremedicaltermswhichdoctorsusewhendescribingthiscondition.Therearenumerousreasonsforhavinglegpainandeverylegpainisnotsciatica.Commonlypeoplemisinterpretsciaticaasadiseaseandneedtobeexplainedthatitisasymptomoftheunderlyingproblem.

2.Whataresymptomsofsciatica?

Theseverityandsymptomsmanyvaryconsiderably.Inseverecasestheaffectedindividualmayfinditdifficulttowalkorevenstandupstraight.

Someofthecommonlyobservedsymptomsinclude

• Sharp,burning,stinging,shooting,electricshockorcrampslikepaininoneorbothlegsoftenasfardownasthefoot.Movement,coughingandsneezingcanintensifythepain

• Tingling,pinsandneedlesand/ornumbnessinlegorfoot• Muscleweaknesswithdifficultyinweightbearingorwalking• Buttock/lowbackpainandstiffness.

3.Whatcausessciatica?

Nervesleavethespinethroughsmalltunnelsoneithersideofspine.Anumberofthesecombinetoformsciaticnerveoneachside.Pressure/irritationofanyofthesenerveseitherinsidethespineorastheyexitthespineoroutsidethespinealongthelengthofthesciaticnerve,canleadtosciatica.Sothecauseofsciaticacanlieinsideoroutsidethespine.Someofthecausesofsciaticaareexplainedbelow

• Discherniation:

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Spineisformedofmanybonescalledvertebraearrangedoneabovetheother.Inbetweenthesevertebraearediscs,whicharelikecushionsorshockabsorbers.Thediscsaremadeupofanoutertoughsubstanceandaninnersoftjellylikesubstance.Herniationofthedisccanoccurifthereissplittingorcrackintheouterlayersallowingtheinnerjellylikesubstancetoprotrudethroughthecrack.Thiscancauseinflammationandcompressionofthenerverootsinthevertebralcolumn.Slippeddiscisacommonlyusedtermforthiscondition.Thereisanincreasedsusceptibilitytodischerniationasweagebecausethesoft,jellylikesubstancedriesoutandshrinkswithtime,makingthediscmorefragile.

• Spinalstenosis:Stenosismeansnarrowing.Thenarrowingcanbeofthecentralcanalofthespineorthepassageways/tunnelsfromwhichthenervesexitthespine.Besidesdiscproblems,arthritisofthespinaljointsorthickeningofligamentscanalsocause/contributetothenarrowing.

• Spondylolisthesis:Inthisconditionthereisaproblemwiththealignmentofvertebrae,whereonevertebraismoreforwardorbackwards,whichcannarrowthespacesfornervesandproducesciaticaasaresult.

• Piriformissyndrome:Inthisconditionpiriformismuscleinthepelvisisresponsibleforpressureonsciaticnerve.

• Trauma/fractures• Spinaltumorsandinfectionsarerarecausesofsciatica

4.Canitresolveonitsown?

Fortunatelymostcasesofsciaticaresolvewithinaperiodofweekstomonthswithconservativetreatment.Specialistinputandtreatmentcanhelp.Painkillers,heatorcoldpack,alteredactivitylevelsandphysicaltherapymaybesuggesteddependingonyourcondition.Aninjectionofsteroidsintotheepiduralspacewithinthespinecanprovideshort-termpainreliefinsciatica.Persistentpaincanleadtochangesinthenerves(referredtoasplasticity).Thiscanbeasourceofpersistentpaineveniftheoriginalincitingeventisresolved…hencetheimportanceofmanagingthesesoonerthanlater.

Havingseennumerouscasesovertheyears,Iwouldsaythatitisnoteasytopredictthecourse.Itcanresolvebuttowhatextenddependsonnumerousfactors-somearemodifiableandothersarenot.Therecoveryperiodvariesfromindividualtoindividual.

5.WhatarethewarningsignsIneedtobewatchfor?Somesymptomspointtowardsaseriousproblemandrequireurgentmedicalattention.Ignoringthesecouldleadtopermanentnervedamage.Someoftheseinclude

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• Lossofurinarycontrol/inabilitytopassurine• Lossofcontroloverstools• Numbnessaroundthebottom• Worseninglegweakness/lossofcontrol

6.WhatcanIdotoreducemyriskofhavingsciatica?

Thoughit'snotpossibletocompletelyeliminatetheriskofsciatica,howeveradoptingahealthylifestylecanhelpinreducingtherisk.Thisincludes

• Givingupsmoking• Regularexercises• Rightpostureandworkergonomics• Healthydietandmaintainingweightinthenormalrange• Usingpropermanualhandlingtechniqueswhileliftingtoavoidbackinjury• StressManagement

7.Whatinvestigationsaregenerallyconsideredforsciatica?Yourdoctormayrequestforinvestigationssuchasmagneticresonanceimaging(MRI)scanandbloodtests.Sometimescomputerizedtomography(CT)scansmayalsoberequired.X-raysarenotashelpfulandtheycanprovideonlylimitedinformation.BulgingdiscsonanMRIscanarenotanuncommonfinding.ItisimportantnottogetfixatedontheMRIfindings.Abulgingdiscisnotpermanentandcanreverse.Theinvestigationresultsshouldbeinterpretedincombinationwithpatienthistory,examinationfindingstoassesstheirsignificance.AnumberofpatientswithsevereMRIfindingsmaybeasymptomaticandviceversa.

8.Whataretheothertreatmentoptions?

Sciaticaisdifferentfromcommonailmentsweallsufferandhencetakingprofessionalhelpisrecommended.Yourdoctorcanhelptoconfirmthatyouhavesciaticaandhelpidentifythecause.Arangeofdifferentoptions-non-surgical(suchasinjections-nerverootblocks,epidurals,piriformisinjectionetc.)orsurgicalmaybeconsidered.Thereisnoonesolutionforsciaticapainandtheoptionsarenumerous-somewithgoodevidenceandotherswithnotsorobustevidence.

Generallyamultimodalmultidisciplinaryapproachispreferredasthishelpsinaddressingnotonlythepainbutalsotheimpactofpainonone'slife.Iensurethatthepatientunderstandsthenatureorproblemandthedo’sanddon’ts.Timespentinexplainingtheconditionsandtheexpectedcoursegoesalongwayinfosteringrealisticexpectations.Igenerallyuseacombinationofthemodalitiesmentionedbelowtoenhancethechancesofquickerrecovery.

Painrelief:

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Painreductionachievedbymedicineshelptomaintainactivityandimprovesphysiotherapycompliance.Themedicationsuseddependonthetypeandseverityofpain,durationofsymptomsandindividualfactorssuchascomorbiditiesandallergies.Someofthecommonlyprescribedpainkillersinclude

• Nonsteroidalanti-inflammatorydrugs(NSAIDs)ThisincludesdrugssuchasDIclofenac,Naproxen,Aceclofenac,Ibuprofenetc.NSAIDsareprescribedtoreducethepainandinflammationduringperiodsofacutesciaticaalthoughtheevidencesupportingtheiruseisnotveryrobust.Theriskbenefitrationeedstobeevaluatedwhileprescribinganydrugs.

• NeuropathicpainkillersThisgroupincludesantidepressantsandanticonvulsantsbothofwhicharewellknownpainkillersfornervepain.Itgenerallytakesafewweeksforthefulleffectsofthesedrugstobecomeapparent.Effectssuchasreducedanxietyandsedationcanbeusedbeneficiallybytailoredselectiontosuitindividualpatients.TheiruseissupportedbytheNICEguidelines,UK.

• Opioids Weakopioidssuchastramadolareoftenprescribedduringpainflareupepisodes.Itisagoodpracticetobeawareofthesideeffectsofamedicinepriortousingit.

• MusclerelaxantsTheseareusedforshortdurationtorelieveanymusclespasmcontributingtothebackpain.

SpinalInjections:

Theuseofepiduralsteroids/Nerverootblockshasbeenshowntohavebeneficialimprovementsinlegpainanddisabilityscoresinshortterm.Steroidshelpbytheiranti-inflammatoryandanalgesic(painrelieving)effect.Epiduralsteroidsarepreferredtooralsteroidsastheyaregivenclosetositeofactualproblemandhavelessadverseeffects.

Physiotherapy:

Physiotherapyisanessentialcomponentofsciaticatreatment.Yourphysiotherapistcanhelpwithpostureadvice,do'sanddon'tsrelevanttoyourcondition,understandingtheconceptofpacingofactivities,settingpracticalgoals,teachingstrengtheningexercisesforcore,legmusclesandmanualhandlingtechniques.

Surgery:

Ifacombinationofabovefailstoprovideadequatereliefthensurgicaloptionssuchasdiscectomy(operationtoremovebulgingpartofthediscorseparateddiscfragments)andmicrodiscectomycanbeconsideredforsciaticaresultingfromdiscbulge.Surgicaloptionswillvarydependingonthecauseofsciaticaandsometimesmaybethefirstchoice,dependingontheactualpathologyanditsseverity.