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A pain in the bum!

July 2017

man with back pain leaning on sofa

Most of us lucky enough not to suffer from sciatica think of it as a general back pain. But while that can be a reasonable description, in some cases sciatica pain can be so crippling that it can cause total disruption to normal life.

This is because the nerve affected by sciatica – the sciatic nerve – is the longest and also the widest nerve in the body. It runs from the lower area of the back right through the buttocks and down the legs, ending just below the knees.

So anything that is causing irritation and pain to this nerve can radiate across a large area, and the pain can be anything from mild to severe.

The sciatic nerve is important because is controls many of the muscles in our lower legs and also provides the sensation we can feel even as far down as the foot.

Sciatica is not just one condition; it generally covers any problem that affects the sciatic nerve. A usual cause is a compression in the lower spine or a slipped (herniated) disk in the spine.  But there can be other causes including tumours growing within the spine and causing pressure on the sciatic nerve. An injury to the spine, perhaps after a fall, or occasionally even infection can also cause a problem with the sciatic nerve.

Whatever the cause, the pain can be crippling and to determine the best treatment, first the cause needs to be established. This can include x-rays and MRI or CT scans and also other investigations to find out the root of the problem. Finding the cause and locating the area causing the problem is key to getting the right treatment.

In mild cases, simple pain relief or anti-inflammatory medication such as ibuprofen can do the trick. Sometimes oral steroids are recommended to relieve any inflammation.

But there are lots of other ways forward as well for sciatica. Epidural steroid injections have strong anti-inflammatory effect and can be sent directly to the root area causing the problem. Some types of antidepressants such as amitriptyline and duloxetine have been found to help relieve nerve pain, and anticonvulsants such as gabapentin have also found to be useful here.

In some cases, manual therapy, perhaps by a physiotherapist, chiropractor or osteopath can help ensure the cause of the problem is reduced or removed, so once the initial inflammation subsides, the problem goes away. Corticosteroid or local anaesthetic injections can also sometimes be prescribed, delivering a strong anti-inflammatory and painkilling medication directly to the problem area.

In most cases the problem can be solved, but for a few when nothing else is working, surgery can be recommended. This usually can involve lumbar decompression surgery, which involves several different techniques including fusion surgery when the vertebra causing the problem is repositioned with a metal or plastic cage supported with metal rods and screws; or laminectomy when a section of the vertebrae is removed.

A great deal of research has been done on sciatica, and there is a lot of information available on the internet including spinal-foundation.org


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