Sciatica

What is it?

The sciatic nerve is a nerve that originates in the lower back (formed by the L4-S3 spinal nerves) on either side of the spine. It runs through the buttocks and into the hips before branching down each leg.  It is the longest nerve in the body and supplies sensation to the leg and foot.

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Sciatica is the term used to describe pain which radiates down the leg and is a symptom itself rather than a specific diagnosis.  This is caused by irritation of the sciatic nerve and is often accompanied with back pain but more often the leg pain is worse than the back.

What are the symptoms and are they concerning?

Sciatica is seldom a sign of a serious problem, but is unpleasant when you are suffering severe pain. The pain experienced reflects irritation or compression to a nerve while numbness or weakness is a sign of nerve damage. Patients tend to have more pain on sitting than standing and symptoms are usually one sided. Many cases of sciatica resolve without specialist input when good advice and reassurance is given.

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As always, look out for "Red Flag" signs and seek urgent specialist advice if you have any of these signs or symptoms:

• Bowel or bladder incontinence/retention

• Pain shooting down both legs

• Numbness in groin or saddle (bottoms) area

• Worsening numbness or weakness

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Treatments

Acute sciatica can be very painful but the vast majority of cases can be treated without surgery.  In the early stages, an accurate diagnosis, adequate painkillers and some manual therapy exercises are indicated.  Most episodes will settle within a few weeks.

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Alongside simple analgesia such as Paracetamol, Codeine and Ibuprofen, a class of drug known as "anticonvulsants" are particularly effective for nerve entrapment pain.  Examples of anticonvulsant drugs include Gabapentin and Pregabalin but as with all medication, there can be side effects (dizziness, nausea, rash etc.).  A low dose of medication originally designed to treat depression (Amitriptyline, a tricyclic antidepressant) can also be useful to combat sciatica pain and the main effect of drowsiness may be beneficial if sleep is being interrupted.

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Introducing a strong anti-inflammatory (corticosteroid) around the inflamed nerve and disc via a selective nerve root injection can be extremely beneficial and often help avoid more major intervention.  The injections are pain free and performed on a day case basis.

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If all conservative measures fail, then surgery to free up the trapped nerve is indicated.  An outpatient consultation with Mr. Lau will help decide what treatment is best for you.

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