Sciatica

The term sciatica describes leg pain with or without back pain. It may be accompanied by other symptoms including tingling, burning and weakness in the leg. It is generally one sided and typically involves the buttock and the back of the leg up to the ankle or the foot. Most patients with sciatica improve within 6 to 12 weeks and do not need any specific treatment except painkillers. In some patients sciatica may persist and become more intrusive with daily activities.

90% of cases sciatica is caused by a herniated disc with nerve root compression, but lumbar stenoses and less often, tumours are possible causes. An estimated 5%-10% of patients with low back pain have sciatica, whereas the reported lifetime prevalence of low back pain ranges from 49% to 70%.

Risk factors for Sciatica

  • Age (peak 45-64 years)
  • Increasing risk with height
  • Smoking
  • Mental stress
  • Strenuous physical activity—for example, frequent lifting, especially while bending and twisting
  • Driving, including vibration of whole body

Sciatica is mainly diagnosed by history taking and physical examination. By definition patients mention radiating pain in the leg. Sciatica is characterised by radiating pain that follows a dermatomal pattern. Patients may also report sensory symptoms.

Diagnostic imaging is only useful if the results influence further management. In acute sciatica the diagnosis is based on history taking and physical examination and treatment is conservative (non-surgical). Imaging may be indicated at this stage if there are ‘red flags’. Diagnostic imaging may also be indicated in patients with severe symptoms who fail to respond to conservative care for 6-8 weeks. In general the clinical course of acute sciatica is favourable and most pain and related disability resolves within 4 to 6 weeks. However up to 30% patients may continue to have pain for one year or longer

Characteristic symptoms of sciatica include

  • Pain in the buttock or leg up to the foot
  • Burning or tingling
  • Sharp, shooting pain
  • Weakness and numbness in the leg
  • Pain worse with bending and walking
  • Pain exacerbated by coughing and sneezing

Treatment options for sciatica include

  • Painkillers including specific medication that works on nerve pain ( Anti neuropathic drugs)
  • Injections (Nerve root blocks, epidural injections)
  • Surgery (microdiscectomy)

Pain Spa management protocol for sciatica

  • Confirmation of diagnosis (MRI scan)
  • Management of pain (pain killers, specific medications, interventional treatments)
  • Nerve root block for diagnosis and therapeutic benefit
  • Rehabilitation (Physiotherapy)
  • Referral to Neurosurgeon if indicated

Summary

Sciatica refers to leg pain secondary to nerve root irritation in the lower back. Most cases of sciatica will settle within 6-12 weeks with conservative management. However some patients may need interventional treatments including injections and/ or surgery to treat the leg pain.

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