Pain Management for Sciatica (Lumbar Radiculopathy)


SciaticaSciatica is a term used to describe a variety of different pains in the lower back and legs. However, it is important to note that “sciatica” is not a true medical diagnosis. Instead, it is a symptom of an underlying medical condition. The proper medical term for sciatica is “lumbar radiculopathy,” a condition characterized by pain radiating from the lower back into the legs.

The sciatic nerve is the largest single nerve in the body, composed of several smaller nerve roots that branch out from the lumbar (lower) region of the spine and run down each leg. Pain in this nerve can range from a minor twinge to severe, debilitating pain.

What Causes Sciatica?

Although this not a complete list of causes related to sciatica, the medical conditions that commonly cause sciatica include:

  • A lumbar herniated disc (also called a slipped disc).
  • Lumbar spinal stenosis (narrowing of the spinal canal).
  • Degenerative disc disease (usually a result of aging).
  • Bone spurs.
  • Small stress fractures of the vertebral.
  • A spinal tumor.

Other conditions that may cause sciatica are:

  • Pregnancy. The changes the body goes through during pregnancy, including weight gain, shifting of one’s center of gravity and hormonal changes can cause sciatica.
  • Scar tissue. The scar tissue can compress the spinal nerve roots in the lower back (a condition called epidural fibrosis) and cause sciatica.
  • Muscle strain. Inflammation related to a lower muscle strain and/or muscle spasm can put pressure on a nerve root and cause sciatica.
  • Fracture. A fracture of one of the lumbar vertebra can cause sciatica.
  • Ankylosing spondylitis. A condition characterized by chronic inflammation in and around the spine is ankylosing spondylitis, which can cause sciatica.

Risk factors that can lead to developing sciatica:

  • Age. Age causes changes in the spine that can trigger sciatica.
  • Obesity. The increased stress on the spine from excess body weight contribute to spinal changes that can trigger sciatica.
  • Occupation. A job that requires twisting of the back, carrying heavy loads, or driving a motor vehicle for long periods of time might play a role in sciatica.
  • Prolonged sitting or a sedentary lifestyle. People with a sedentary lifestyle are more likely to experience sciatica than people engaged in an active lifestyle.
  • Diabetes. A condition that increases the risk of nerve damage resulting in sciatica is diabetes.

Factors that may worsen back pain include being overweight, not exercising regularly, wearing high heels, and sleeping on a mattress that is too soft.

What are the symptoms of Sciatica?

The symptoms of sciatica differ depending on where the sciatic nerve is affected. Usually, sciatica affects only one side of the lower body and the pain radiates from the lower back to the back of the thigh, down the leg and sometimes into the foot. Lower back pain, may or may not be present. The condition can cause weakness or numbness in parts of the affected leg and foot.

In varying combinations, the most common symptoms of sciatica are:

  • Constant pain in only one side of the buttock or leg (rarely in both sides).
  • Pain that originates in the lower back, or possibly even the buttock, that continues along the sciatic nerve, down the back of the thigh and into the lower leg and foot.
  • The pain subsides when lying down or walking, but worsens when standing or sitting.
  • Pain often described as being sharp or searing, rather than dull.
  • A “pins-and-needles” sensation down the leg.
  • Weakness or numbness when moving the leg or foot.

These symptoms may intensify during sudden movements, like a sneeze or a cough.

How is Sciatica Diagnosed?

As with all pain management, the diagnostic procedures for sciatica include a complete medical history and physical examination. Also, the doctor may conduct the following tests:

  • X-ray to produce images of internal tissues, bones, and organs.
  • Magnetic resonance imaging (MRI). A special imaging procedure to produce detailed images of organs and structures within the body.
  • Electromyography (EMG ) and nerve conduction study (NCS). Two diagnostic procedures usually conducted together to record electrical activity in the muscles and determine if nerves are functioning normally.

How is Sciatica Treated?

Because an underlying medical condition causes sciatica, treatment will address the cause of symptoms rather than just treat the symptoms. In some cases, self-care may be all that is required. However, if self-care measures do not help with pain management, the following treatments may be appropriate, depending on the cause of the pain:

Nutrition and exercise. Exercise improves the pain of sciatica by increasing flexibility and the range of motion. Exercise also releases endorphins, the body’s natural pain relievers. Nutrition and healthy eating will help combat any nutritional deficits in the body.

Biofeedback. The process of biofeedback helps a patient become aware of normally involuntary processes inside the body (such as blood pressure, temperature, and heart rate control). Biofeedback helps you gain some conscious control of these processes which can influence and improve your level of pain. This awareness of the body helps the patient to relax which can help relieve the pain.

Deep Tissue Massage. Focused rubbing of tender areas may help relieve muscle spasms or contractions and improve the discomfort associated with it. Massage can also help you relax, decreasing stress and tension.

Physical Therapy. Once acute pain is under control, a physical therapist may design a rehabilitation program to help prevent future injuries. Physical therapy strengthens your muscles and gets you back to your daily activities. Typical physical therapy involves exercises designed to correct posture and strengthen the muscles supporting your back. These exercises also help improve flexibility. A qualified physical therapist can help you with stretches, strength exercises, and low-impact cardio without straining your back.

Acupuncture. Small needles inserted into the skin cause the body to release hormones called endorphins. Endorphins are the body’s natural pain relievers. Acupuncture also helps you relax, decreasing stress, tension, and muscular spasm.

Medications. Sciatica pain  may feel better with over-the-counter pain relievers. NSAIDs (ibuprofen-like drugs), acetaminophen (such as Tylenol), muscle relaxants, and membrane-stabilizing medications are often effective in treating low back pain. In some cases, pain-relieving creams can be helpful for muscle aches. In cases of severe or chronic pain, prescription medication may be necessary.

Steroid injections. In some cases, the injection of a corticosteroid medication into the area affecting the nerve root helps reduce pain by suppressing inflammation around an irritated nerve. However, the effects of these injections last only a few months. Plus, there may be serious side effects to using steroid injections, so there is a limit to the number of injections and how often you can receive them.

Trigger point injections. This procedure involves injecting a local anesthetic and steroid into a “trigger point.” These are usually effective for treating muscle spasms.

Transcutaneous electrical nerve stimulation (TENS). This technique relieves pain by applying a mild electrical current to the skin at the site of the pain. The electric impulses interfere with normal pain sensations.

Disc Decompression. In this procedure, a needle is inserted through the skin into the affected disc to suction out disc material from the bulging disc to relieve pain caused by pressure within the disc.

Spinal cord stimulation (SCS). An implanted electrical device decreases the perception of pain by confusing the spinal cord and brain pain processing centers. A small electrical lead placed in the epidural space next to the spinal cord replaces pain signals with electrical signals. If you have success during a trial period, you may decide to have a permanent SCS device implanted to help you long-term.

Epidural Steroid Injections (ESI). ESI involves injecting a long-lasting steroid and an anesthetic mixture into the epidural space near the irritated nerve root. The steroid reduces inflammation and irritation. The anesthetic interrupts the pain signal. The medication spreads to other portions of the spine, reducing inflammation and irritation.

Lysis of adhesions (“Racz Procedure”). This procedure is effective in removing excessive scar tissue in the epidural space when conservative treatment for lower back pain has failed. A 2005 study found that “spinal adhesiolysis with targeted delivery of local anesthetic and steroid is an effective treatment for a significant number of patients with chronic low back and lower extremity pain without major adverse effects.” We can use this procedure when we find vertebral body compression fractures, post-laminectomy syndrome, radiculopathy, or disc disease.

Infusion techniques. This procedure involves inserting a small catheter into the epidural space or directly next to affected spinal nerves. The catheter delivers a local anesthetic, and other medicines, for extended time periods. When the nerves are blocked continuously with an infusion, pain relief can be dramatic and long-lasting.

Intrathecal pump implants. An intrathecal pump works to relieve chronic pain by inserting small amounts of medicine directly into the area surrounding the spinal cord (intrathecal space) to prevent pain signals from reaching the brain.

Surgery. This option is usually reserved for circumstances when there is a significant weakness, a loss of bowel or bladder control, progressively worsening pain with patients who are not improving with other therapies.

Although we have several treatment options listed, it is important to remember that we base specific treatment options for sciatica on:

  • Your age, overall health, and medical history.
  • The extent of the underlying condition.
  • Your tolerance for medications, procedures, or therapies.

Novus Spine & Pain Center

Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating sciatica. By using a comprehensive approach and cutting edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.


Sciatica Resources

Sciatica  (Wikipedia)

What You Need to Know About Sciatica  (Spine Health)

Sciatica (Mayo Clinic)

Pain Management and Sciatica  (WebMD)

Sciatica  (Johns Hopkins Medicine)