Sciatica refers to a wide range of symptoms that can affect parts of the body ranging from the lower back to the feet. Symptoms can include moderate or severe pain, numbness, tingling, problems with motor control, and sensitivity to cold. The term takes its name from the sciatic nerve, the longest and widest nerve in the human body.
Because there are so many variations on the presenting symptoms, and because there are so many points at which the sciatic nerve can be irritated, sciatica can be a difficult problem to diagnose and treat. There are simply too many possible causes, so additional information will usually be needed to identify and treat the source of the symptoms.
Among the more common causes of sciatica are lumbar and epidural issues. If the lumbar disc is herniated, the problem will correct itself in most cases. Other common causes will likely require some kind of medical intervention. For example, an epidural abscess or tumor will need to be fixed in order to resolve the problem.
Because sciatica is such a vague condition, the cause may also be idiopathic, meaning the cause is unknown. The complex set of causes and symptoms also limits the ability of clinical trials to identify the most effective treatments. The issue is so muddled that some studies have not even been able to tell whether exercise is better than its polar opposite, bed rest. Other studies have had difficulty establishing a difference in outcomes between medications and placebos. Surgical intervention appears to have a short-term effect, but there are no statistically significant benefits in the medium or long-term outcomes. Spinal manipulation can also provide relief for some patients.
For patients whose doctors cannot pinpoint the cause of the symptoms, it’s still worth trying to treat the symptoms. Patients simply need to find the treatment that works best for them. This could include simple, less aggressive treatments like cold packs and hot packs. If these methods fail to provide relief, the more aggressive interventions can be used, such as drugs or surgery.
Several different categories of drugs can be used depending on the specific symptoms involved. NSAIDs (non-steroidal anti-inflammatory drugs) are popular and effective painkillers. Aspirin and ibuprofen, available over the counter, are examples of this class of drugs. Some Muscle relaxants can be used if the nerve issues are causing muscle tension. Opioids are another possibility, although those should be avoided when possible due to the risk of developing dependency. Corticosteroids appear to be at least a short-term fix for some patients, although their use should be limited due to potential side effects.
Other sciatica medications might sound counterintuitive. Some doctors might recommend tricyclic antidepressants to boost the body’s endorphin levels. Endorphin is a natural hormone that helps suppress pain. They may also prescribe anticonvulsants to prevent the pain signals from being processed in the patient’s brain. Think of this as having the body still technically be in pain, but it doesn’t fully register.
If you are suffering from sciatica, it is important to talk to your doctor and try to identify the source of the problem. Depending on the cause of your symptoms, the appropriate treatment regimen may vary.