Sciatic Neuropathy Health Article

Causes and symptoms

As previously noted, the most common cause of sciatica is a "slipped" or herniated disk, also called a prolapsed intervertebral disk (PID) or a herniated nucleus pulposus. Any trauma or injury to the nerve will result in swelling and inflammation. While this healing condition persists, the nerve will respond with pain, which in turn, will often reduce normal movement.

Rarely, sciatic neuropathy has been reported after surgical procedures that required the patient to be immobilized in the operating room for long periods of time or in positions that may have irritated the sciatic nerve.

Diagnosis

Sciatica is in itself a symptom of some other condition which must be diagnosed by a physician. The root causes of the disorder may vary. Only a professional who is trained in recognizing the information provided by the patient and laboratory results can determine if or whether the condition is an isolated symptom or a symptom of a more general or serious disorder of the patient.

Although the diagnosis is based primarily upon symptoms of pain, the physician will usually test for muscle strength, reflexes and flexibility while considering a diagnosis of sciatic neuropathy. Areas of spinal problems that may cause sciatic nerve irritation or compression are usually visible on MRI or CT images. Occasionally, further nerve function tests may be necessary.

Treatment team

Physicians are the first contact to be made in a treatment team. It is the physician who must first make the diagnosis. A radiologist or laboratory technician may take x rays of the area to look for bone spurs of disk protrusions. Once the diagnosis is made the pharmacist may be called to provide appropriate medication for treatment. In more severe cases, a physical therapist may be used to keep the patient active and performing physical tasks that help reduce the pain. With intractable pain, a neurosurgeon may be consulted for surgery.

Treatment

The immediate treatment of most cases of sciatica is to recommend medications specific to the inflammation. Staying active is also highly recommended, while avoiding activities that put pressure on the back. Studies have found that a simple combination of anti-inflammatory medication such as ibuprofen and mild exercise, such as walking, are effective treatment for most cases of common sciatica. Sometimes an epidural injection (an injection to the epidural space of the spine) may provide pain relief. Surgery for a herniated disk is an aggressive alternative, and includes more risk.

Recovery and rehabilitation

The majority of patients suffering with sciatica recover in a few weeks to six or seven weeks. While the pain may be intense for some sufferers, it is usually temporary. With treatment, person has an excellent chance for reduction or resolution of the neuropathy pain of sciatica.

Clinical trials

A large clinical trial testing the effectiveness of new drug therapies is being conducted by the National Institute of Dental and Craniofacial Research (NIDCR). This may seem like an unlikely group to sponsor such a trial, but any study that examines the effectiveness of medication on nerves may be of great aid to patients suffering from sciatica. Information on additional clinical trials can be found at the United States government website for clinical trials: <http://www.clinicaltrials.gov>.

Prognosis

The prognosis for the pain relief of most cases of sciatica is excellent. With a combined use of anti-inflammatory drugs and mild exercise, such as walking, sciatica can be reduced and even eliminated. If the underlying cause is more serious, the prognosis varies with the degree of severity and type of condition.

Special concerns

One of the myths associated with sciatica is the need to rest in bed. In fact, mild exercise is one of the best treatments for the pain. Prolonged sitting is a primary cause of many cases of sciatica. If a job requires extended periods of sitting, it is wise to take short walks or perform mild stretches to keep compression of the lower lumbar vertebrae from occurring.

BOOKS

Burn, Lois. Back and Neck Pain: The Facts. New York: Oxford University Press, 2000.

Fishman, Lauren, and Carol Ardman. Back Pain: How to Relieve Low Back Pain and Sciatica. New York: W. W. Norton & Company, 1999.

OTHER

National Library of Medicine. "Sciatica." MEDLINE plus. (February 11, 2004). <http://www.nlm.nih.gov/medlineplus/sciatica.html>.

ORGANIZATIONS

American Chronic Pain Association (ACPA). P.O. Box 850, Rocklin, CA 95677. (916) 632-0922 or (800) 533-3231; Fax: (916) 632-3208. ACPA@pacbell.net. <http://www.theacpa.org/>.

National Institute of Arthritis and Musculoskeletal and Skin Dieseases (NIAMS). National Institutes of Health, Bldg. 31, Rm. 4C05, Bethesda, MD 20892. (301) 496-8188; Fax: (540) 862-9485. ncpoa@cfw.com. <http://www.niams.nih.gov/index.htm>.

Brook Ellen Hall, PhD