FAQs on Sciatica and Treatment Options

 

 


Sciatica is pain of the lower extremity that results from sciatic nerve irritation. The discomfort of sciatica occurs from the lower back to behind the thigh, and it often radiates down below the knee.

The sciatic nerve arises from nerve roots of the lumbar spinal cord, branches to extend through each buttock area, and sends nerve endings down the leg. The sciatic nerve is the largest nerve in the body, and the pain associated with it is called sciatic nerve pain.

What causes sciatica?

Any condition that causes irritation or inflammation to the sciatic nerve can produce symptoms of sciatica. Most often the result of a lumbar disc herniation, sciatica can occur from any structure of the spine that presses on the sciatic nerve. When the nerves are irritated due to an abnormal intervertebral disc, the pain is referred to as radiculopathy. Sciatica can occur from an adjacent bone, injury, tumors, internal bleeding, or infections in and around the lumbar spine.

How common is sciatica?

Radicular pain is a frequent and often debilitating occurrence. The lifetime incidence of sciatica is estimated to be between 13 and 40%.

However, the majority of cases resolve spontaneously, only requiring simple medications and physical therapy. However, if sciatica becomes chronic and intractable, there can be major socio-economic implications.

Who is at risk for sciatica?

Several risk factors increase the likelihood of sciatica. These include:

  • Increasing height
  • Age of 30 to 50 years
  • A genetic predisposition
  • Certain occupations, such as driving or operating heavy machinery
  • Degenerative lumbar spinal arthritis
  • Degenerative disc disease
  • Herniated disc
  • Trauma to the spine

What are the symptoms associated with sciatica?

Sciatica often feels like a bad leg cramp, with the pain often described as “knife-like,” sharp, shooting, or electrical. This can last for weeks or months. Pain is often worse with moving, coughing, and sneezing.

Some patients have additional symptoms of weakness, tingling, numbness, and/or burning down the leg. Sometimes, the symptoms of sciatica are worsened by bending at the waist or walking, and many patients report relief with lying down or changing positions.

How is sciatica treated?

Treatment of sciatica depends on the cause of symptoms and the severity of the underlying condition. Options include:

  • Medications – Commonly prescribed drugs include tricyclic antidepressants, anti-inflammatory agents, muscle relaxants, and anti-seizure agents.
  • Physical therapy – This is prescribed to help the patient prevent recurrent injuries and teach exercises to correct posture, improve flexibility, and strengthen muscles.
  • Epidural steroid injection (ESI) – The doctor injects a long-acting steroid, with or without an anesthetic, into the epidural space, which lies between the epidural layer and the spinal cord. According to recent clinical studies, the efficacy rate of ESI is 85-90%.