Taming the pain of sciatica: For most people, time heals and less is more

Despite being a less common cause of low back pain, sciatica is still something I regularly see as a general internist. Primary care doctors can and should manage sciatica, because for most individuals the body can fix the problem. My job is to help manage the pain while the body does its job. When a person’s symptoms don’t improve, I discuss the role of surgery or an injection to speed things up. What is sciatica? Sciatica refers to pain caused by the sciatic nerve that carries messages from the brain down the spinal cord to the legs. The pain of sciatica typically radiates down one side from the lower back into the leg, often below the knee. The most common cause is a bulging (“herniated”) disc in the lower back. Discs are tire-like structures that sit between the bones of the spine. If the outer rim of the disc tears, usually due to routine pressure on the lower back, the jelly-like inner material can come out and pinch or inflame the nearby nerve. Sciatica is most common in people 30 to 50. How do you know if it is sciatica? The key to diagnosing sciatica is a thorough history and a focused exam. Unfortunately, many patients expect an x-ray or MRI, and doctors, often facing time constraints, order one even though we know imaging tests don’t really help us treat early sciatica any better. The symptoms of sciatica are often worse with sitting or coughing, and may be accompanied by numbness or tingling in the leg. A physical exam can confirm tha...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Back Pain Health Pain Management Source Type: blogs

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Authors: Enke O, New HA, New CH, Mathieson S, McLachlan AJ, Latimer J, Maher CG, Lin CC Abstract BACKGROUND: The use of anticonvulsants (e.g., gabapentin, pregabalin) to treat low back pain has increased substantially in recent years despite limited supporting evidence. We aimed to determine the efficacy and tolerability of anticonvulsants in the treatment of low back pain and lumbar radicular pain compared with placebo. METHODS: A search was conducted in 5 databases for studies comparing an anticonvulsant to placebo in patients with nonspecific low back pain, sciatica or neurogenic claudication of any duration...
Source: Canadian Medical Association Journal - Category: General Medicine Tags: CMAJ Source Type: research
Low back pain is a highly prevalent condition, causing considerable disability and burden globally19. Up to 70% of people will experience low back pain during their lifetime54. Patients with low back-related leg pain, such as sciatica, experience intense radiating leg pain that may be accompanied by neurological signs20 and both low back pain and sciatica are associated with high healthcare costs, work absenteeism and economic burden19,53.
Source: The Journal of Pain - Category: Materials Science Authors: Tags: Review Article Source Type: research
CONCLUSION: Psychosocial risk factors of chronic back pain, such as chronic stress, depressive mood, and maladaptive pain processing are becoming increasingly more recognized in competitive sports. Screening instruments that have been shown to be predictive in the general population are currently being tested for suitability in the German MiSpEx research consortium. PMID: 29946960 [PubMed - as supplied by publisher]
Source: Schmerz - Category: Anesthesiology Authors: Tags: Schmerz Source Type: research
Abstract Here, we examine the stark contrast between the successes and failures of the clinical development of analgesics for different types of chronic low back pain (CLBP) syndrome over the past three decades. Multiple drugs with differing mechanisms of action have been developed for nonspecific axial-predominant low back syndromes and yet not a single therapy is indicated for any neuropathic low back pain syndrome (e.g., sciatica). Clinician findings have informed the entry criteria for neuropathic low back pain clinical trials, whereas entry criteria of axial CLBP trials have prioritized only patient reports o...
Source: Drug Discovery Today - Category: Drugs & Pharmacology Authors: Tags: Drug Discov Today Source Type: research
Abstract When managing acute nonspecific low back pain (LBP), bed rest is commonly discouraged as a form of therapy. However, when the picture includes radiating leg pain arising from the lumbar spine, the evidence is less robust. In this Viewpoint, the authors explore evidence pertaining to sciatica, defined as "low back pain with verified neurological deficits," and bed rest as part of the management of radiating leg pain. J Orthop Sports Phys Ther 2018;48(6):436-438. doi:10.2519/jospt.2018.0609. PMID: 29852836 [PubMed - in process]
Source: Physical Therapy - Category: Physiotherapy Authors: Tags: J Orthop Sports Phys Ther Source Type: research
Conditions:   Lumbar Radiculopathy;   Lesion of Sciatic Nerve, Left Lower Limb;   Lesion of Sciatic Nerve, Right Lower Limb;   Lumbar Spinal Stenosis;   Lumbar Spondylosis;   Lumbago With Sciatica, Left Side;   Lumbago With Sciatica, Right Side Intervention:   Procedure: Osteopathic Manipulative Treatment (OMT) Sponsors:   Rowan University;   American Osteopathic Association Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Low back pain (LBP) is a highly prevalent condition and it is associated with significant disability and work absenteeism worldwide. A variety of environmental and individual characteristics have been reported to increase the risk of low back pain (LBP). To our knowledge, there has been no previous attempt to summarise the evidence from existing systematic reviews of risk factors for LBP and/or sciatica
Source: The Spine Journal - Category: Orthopaedics Authors: Tags: Review Article Source Type: research
This article reviews the clinical questions and bottom-line answers from these studies. Blood pressure should be measured after a period of rest, using a bare arm, and orthostatic blood pressure is more predictive when measured after one minute of standing rather than three minutes. Intensive blood pressure lowering results in cardiovascular benefits but also renal harms in high-risk patients with an average age of 68 years. The initiation of a statin for primary prevention does not reduce cardiovascular events in adults 65 years or older. Sterile gloves do not reduce the risk of infection for common outpatient skin proced...
Source: American Family Physician - Category: Primary Care Authors: Tags: Am Fam Physician Source Type: research
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