Diagnosis of Sciatica

Sciatica pain is usually radiated along the back or the side of the thigh and knee into the leg. Occasionally, patients may present with a confusing picture of knee problem, but maybe having sciatica. A thorough history and examination by the physician as well as diagnostic tests in the form of x-rays and MRI may be needed to confirm the diagnosis.

Sciatica nerve pain can be relieved to various modalities. To start with, antiinflammatory medications like ibuprofen, naproxen or Tylenol may help. If pain is not relieved with the medications, physical therapy, chiropractor and acupuncture may also help. The patient may also take medications including gabapentin or pregabalin for pain relief.

The patient should take a short period of bed rest for a day or two. The patient should continue to do normal usual activities. If the pain is not relieved, he should see his doctor. Epidural injection or nerve root blocks may help in relieving the sciatica pain. Patients who are not having any relief with any of the above-mentioned treatment plans, may need an MRI for confirmation of diagnosis and possibly surgery to relieve their pain.

Sciatica is a clinical diagnosis, which can be corroborated by imagings with or without nerve conduction/EMG studies. Typical patient will present with pain radiating down one leg along the back or the side of the thigh index. They may have been associated with tingling and numbness or back pain.

Occasionally, patients may have weakness in the toes or the ankle. Once the clinical diagnosis is made, confirmation can be done using x-rays and MRI. In patients who have a confusing picture due to underlying comorbidity or atypical presentation, nerve conduction study and electromyographic study can be done to further confirm or rule out sciatica.

Heat is usually better in patients who have sciatica, though patients who are not relieved with heat should also try ice or occasionally rhythmic use of heat and ice, cyclic use of heat or ice may help better than one alone.

Massage is one of the modalities of adjuvant therapy for sciatica can be helpful and can decrease pain by strengthening the muscles as well as stretching the nerves. Deep massage can also help decrease the muscle spasms that develop in patients with sciatica.

For sciatica, an ice pack or even a heating pad can be used by placing it into the lower back and the gluteal region. It helps decrease the inflammation of the nerve there and thereby decreasing the pain and associated symptoms.

Inversion table similar to traction helps sciatica by increasing the height of the disk and thereby allowing the disk to go back into space thereby decreasing the compression of the nerve root may help in decreasing the pain of sciatica. The issue of inversion table as well as traction is that this is effective until the patient uses them and once the patient is upright and moving, the effect of the inversion table or the traction may not be persistent.

Sciatica or lumbar radiculopathy causes pain radiating from the back or the hip into the lower extremities down the leg. The pain radiates along the back or the side of the thigh and leg and radiates down foot. An isolated ankle pain may not be caused by radiculopathy. If the pain is on outer or inner side of the ankle and is radiating down or coming from the top then it may be associated with sciatica or lumbar radiculopathy.

90% of patients with sciatica will eventually get better in a period of four to six weeks. During this time, the pain may worsen also or it may keep on improving. Patients who have severe pain with or without tingling or numbness usually will need medical attention to relieve their pain during this duration. The treatment may involve medications, physical therapy and cortisone shots. Patients who have sudden onset of neurological deficit or weakness or worsening of the neurological deficit may need surgery also.

Sciatica like any other neurologic pain can have relation with the mental status and cognitive functions of the person. Though stress may directly not be the causative factor for sciatica, it may have its effect on the severity as well as course of the disease process of sciatica. Patients with high stress levels may have difficulty coping with sciatica and may take longer time to get better.

Sciatica in most patients will get better by itself in a period of four to six weeks. The pain as well as tingling and numbness tend to improve over time, though it may have periods of worsening. Patients may need treatment in the form of medications or injections to relieve the pain, so as to spend this period of four to six weeks, till then the relief is evident.

Occasionally in about 10% of the patients, there will be no relief, worsening or recurrence of sciatica pain despite all treatment modalities over four to six weeks. These patients may need surgical management to relieve their pain due to the pressure over the nerve roots.

Sciatica is usually self limiting in 90% of patients and only needs treatment in the form of medication and physical therapy and occasionally cortisone injection. In about 10% of patients, this may not be relieved by any modality and these patients may need to undergo surgical treatment.

Sciatica can also rarely lead to rapid neurological deficit presenting in the form of cauda equina syndrome, which can be potentially disabling. The neurological deficit caused due to cauda equina syndrome may be permanent especially if not treated early in the disease process. Such patients may not only have weakness in their legs, but may also lose control over their bowel and bladder, which may or may not recover over time.

Sciatica pain can be relieved by the help of anti-inflammatory medications like ibuprofen, naproxen. It can also be helped by Tylenol. Stronger pain medications like tramadol and narcotic medications may occasionally be needed for a short period of time.

Neuromodulator medications like gabapentin and pregabalin may also be helpful in decreasing the sciatica pain. Occasionally, medications like amitriptyline, duloxetine and carbamazepine may also be used in some patients to relieve their pain.

Back brace may be helpful in patients who have back pain with or without sciatica. Patients who have only radicular pain in their lower extremity may not be helped by the back brace. Use of back brace for a long period of time may be detrimental by causing atrophy of the back muscles.