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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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An FDA advisory panel voted 5 to 8 against recommending approval for Intrinsic Therapeutics’s Barricaid prosthesis designed for partial annulus replacement in patients with herniated discs, according to a MedPage Today report. The negative recommendation came based on concerns over the safety of the device, including breakage rate and certain endplate lesions of unknown origin. The same panel voted 12 to 1 in favor of the device’s efficacy, according to the report. “There was a high rate of breakage of the device, a high rate of migration, and [there was] the unknown nature of [some endplate] lesions,&rdq...
Source: Mass Device - Category: Medical Devices Authors: Tags: Food & Drug Administration (FDA) Regulatory/Compliance Spinal Intrinsic Therapeutics Source Type: news
Authors: Lewis DD, Summers GK Abstract Adjacent segment pathology is an adverse effect of spinal fusion that precipitates accelerated spinal degenerative changes at vertebral segments contiguous with the fused vertebrae. The accelerated degeneration related to ASP can be challenging to manage, as it can lead to conditions such as radiculopathy and can create the need for reoperation. In the present case, a 50-year-old woman with a previous spinal fusion presented with a 1-year history of progressive low back pain, lumbar radiculopathy, and sciatica. Osteopathic manipulative treatment was used to manage her pain, an...
Source: Journal of the American Osteopathic Association - Category: Complementary Medicine Tags: J Am Osteopath Assoc Source Type: research
A new treatment that aims electrical pulses at irritated nerves around the spinal cord appears effective at relieving chronic lower back pain and sciatica, a preliminary study suggests.
Source: WebMD Health - Category: Consumer Health News Source Type: news
WEDNESDAY, Nov. 29, 2017 -- A new treatment that aims electrical pulses at irritated nerves around the spinal cord appears effective at relieving chronic lower back pain and sciatica, a preliminary study suggests. The minimally invasive procedure,...
Source: Drugs.com - Daily MedNews - Category: General Medicine Source Type: news
A 61-year-old woman presented to the hospital with acute onset of numbness and weakness in the lower extremities. Her symptoms rapidly progressed, reaching maximal intensity within hours. She developed acute urinary retention but without bulbar or upper extremity involvement. There was no constitutional symptom or preceding trauma. Prior medical conditions included hypertension, hyperlipidemia, left-sided sciatica, and low back pain. Family history was unremarkable.
Source: Neurology - Category: Neurology Authors: Tags: All Clinical Neurology, All Spinal Cord, Arteriovenous malformation, Transverse myelitis RESIDENT AND FELLOW SECTION Source Type: research
ConclusionsLatentP. acnes infection was associated with chronic inflammation in degenerated intervertebral discs, especially in the samples with visible bacteria in histology, which manifested as increased numbers of cytokines and neutrophils. Discs withP. acnes infection had much severer disc degeneration andP. acnes-associated chronic inflammation may be the reason.
Source: European Spine Journal - Category: Orthopaedics Source Type: research
Authors: Sheng X, Cai G, Gong X, Yao Z, Zhu Y Abstract Clinically, it is difficult to differentiate osteoid osteoma, more than 50% of which occur in the fibia or tibia, from other diseases, i.e. spinal degenerative diseases, inflammatory and noninflammatory arthritis. In this case report, we presented an unusual case of lumbar osteoid osteoma in a 38-year-old male, who experienced low back pain and sciatica as initial symptoms. The patient was initially misdiagnosed as lumbar disc herniation for more than 10 years. With the usage of computed tomography (CT) and magnetic resonance imaging (MRI), the patient was fina...
Source: Journal of Back and Musculoskeletal Rehabilitation - Category: Orthopaedics Tags: J Back Musculoskelet Rehabil Source Type: research
Authors: Zhang B, Xu H, Wang J, Liu B, Sun G Abstract Lumbar intervertebral disc herniation (LIDH), as the main contributor to low back pain and sciatica, imposes a heavy burden on both the individual and society. Non-operative treatment or conservative treatment has proven effective in alleviation of the symptoms of LIDH and are considered to be a first-line choice for most cases. Active lifestyle, physical therapy, complementary and alternative medicine therapy or Traditional Chinese medicine (TCM) therapy, and pharmacotherapy are routinely used as effective non-operative treatment for LIDH patients. However, how...
Source: BioScience Trends - Category: Biomedical Science Tags: Biosci Trends Source Type: research
We report the case of a 19-year-old man presenting with lower back pain and sciatica. His radiograph revealed bilateral and symmetrical multiple osteosclerotic bone lesions in both scapular areas. Sanger sequencing of LEMD3 revealed a four-base-pair deletion in intron 2 (c.1560+3_1560+6del), which was inherited from his father. We found that this four-base-pair deletion in intron 2 causes aberrant splicing and consequent deletion of exon 2. To the best of our knowledge, this is the first report of genetically confirmed osteopoikilosis in Korea. PMID: 28840995 [PubMed - in process]
Source: Annals of Laboratory Medicine - Category: Laboratory Medicine Tags: Ann Lab Med Source Type: research
ConclusionsPiriformis syndrome can be defined by a quartet of symptoms and signs. Many physical tests have been described, but the accuracy of these tests and the symptoms cannot be concluded from studies to date. Straight leg raising does not rule out the diagnosis. Piriformis syndrome is at a stage previously encountered with herniated intervertebral disc: that piriformis muscle pathology can cause sciatica has been demonstrated, but its prevalence among low back pain and sciatica sufferers and the diagnostic accuracy of clinical features requires cross-sectional studies free of incorporation and verification biases. One...
Source: European Journal of Orthopaedic Surgery and Traumatology - Category: Orthopaedics Source Type: research
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