Taming the Pain of Sciatica: For Most People, Time Heals and Less is More

Sciatica is characterized by pain resulting from compression or irritation of the sciatic nerve, responsible for transmitting messages from the brain down the spinal cord to the legs. This pain typically extends down one side, from the lower back into the leg, often reaching below the knee. A prevalent cause of sciatica is a bulging or herniated disc in the lower back. Discs, resembling tire-like structures, are situated between the spinal bones. If the outer rim of the disc tears, often due to routine pressure on the lower back, the inner, jelly-like material can protrude, leading to the pinching or inflammation of the nearby nerve. Sciatica is most commonly observed in individuals aged 30 to 50.

How do you know if it is sciatica?

Diagnosing sciatica relies on a comprehensive examination of the patient’s history and a focused physical examination. Sciatica symptoms often intensify when sitting or coughing and may be accompanied by sensations of numbness or tingling in the leg. A thorough physical examination can verify the involvement of the sciatic nerve. In cases where there is muscle weakness or reduced reflexes in the affected leg, an imaging test, such as a back MRI, can be valuable. This diagnostic information helps guide decisions, particularly regarding the potential need for early surgical intervention.

Treating sciatica pain… and managing expectations

Many individuals believe that the severity of pain correlates with the seriousness of the underlying issue, but this is not necessarily true for sciatica. The body has the capability to reabsorb disc material causing symptoms, even in cases of severe pain. Therefore, the primary focus of treatment is pain management and encouraging patients to remain as active as possible.

While short periods of lying down may be beneficial for excruciating pain, prolonged bed rest is discouraged. Once the pain becomes manageable, it’s crucial to resume walking short distances. Prolonged sitting or driving should be avoided, as it increases pressure on the discs in the lower back. While treatments like physical therapy, massage, acupuncture, and chiropractic manipulation are commonly tried, evidence suggests they are less effective for sciatica compared to typical low back pain. Over-the-counter pain relievers such as ibuprofen and naproxen can be helpful. If these are insufficient, short-term use of stronger prescription pain medications may be necessary.

The encouraging news is that for the majority (approximately three out of four) of people, symptoms improve over a few weeks. For those who do not experience improvement after six weeks, surgery becomes a viable option. While surgery can expedite recovery, individuals undergoing surgery are typically doing as well as those opting for natural healing after six to 12 months. The surgical procedure involves removing the disc material affecting the nerve and is generally safe, although rare complications can occur. Furthermore, 5% to 10% of people may not experience improvement or may even have worsened pain after surgery.

Patients often inquire about spinal injections, where steroid medicine is injected into the affected area. This option is worth considering for those with uncontrolled pain or persistent, bothersome symptoms who wish to avoid surgery. While injections can provide short-term relief, they carry uncommon risks, including increased pain, and do not appear to reduce the need for future surgery.