Sciatic nerve pain management

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Sciatic nerve pain is pain resulting from irritation of the sciatic nerve. Sciatic nerve pain is typically felt from the low back to behind the thigh and radiating down below the knee.

The sciatic nerve is the largest nerve in the body and has its origins in the lumbar spinal cord. It extends through the buttock area and sends nerves to the rest of the leg.

While sciatic nerve pain is most commonly a result of a disc herniation directly pressing on the nerve, any cause of irritation or inflammation of this nerve can produce the symptoms of sciatic nerve pain. These cause include irritation of the nerve from nearby bone, tumors, muscle, internal bleeding, infections, injury, and other causes.

Bed rest has been traditionally advocated for the treatment of sciatic nerve pain. But how useful is it?

To study the effectiveness of bed rest in patients with sciatic nerve pain of sufficient severity to justify treatment with bed rest for 2 weeks, a research team in the Netherlands led by Dr. Patrick Vroomen randomly assigned 183 such patients to bed rest or, alternatively, to watchful waiting for this period.

To gauge the outcome, both primary and secondary measures were examined. The primary outcome measures were the global assessments of improvement after 2 and 12 weeks by the doctor and the patient. The secondary outcome measures were changes in functional status and in pain scores, absenteeism from work, and the need for surgical intervention. Neither the doctors who assessed the outcomes nor those involved in data entry and analysis were aware of the patients' treatment assignments.

The results, reported in The New England Journal of Medicine, showed that after 2 weeks, 64 of the 92 (70 percent) of the patients in the bed-rest group reported improvement, as compared with 59 of the 91 (65 percent) of the patients in the control (watchful- waiting) group. After 12 weeks, 87 percent of the patients in both groups reported improvement. The results of assessments of the intensity of pain, the bothersomeness of symptoms, and functional status revealed no significant differences between the two groups. The extent of absenteeism from work and rates of surgical intervention were similar in the two groups.

The researchers concluded that: "Among patients with symptoms and signs of a lumbosacral radicular syndrome, bed rest is not a more effective therapy than watchful waiting." Sometimes conventional wisdom is not as wise as research!

That study aside, what are some of the treatments that are recommended.

Besides rest, other treatment include physical therapy with ultrasound and electrical stimulation, anti-inflammatory medicines, steroid injections, transcutaneous nerve stimulation, ice, traction, and chiropractic.

Sciatic nerve pain summary

• Sciatica is a nerve pain from irritation of the sciatic nerve.
• The sciatic nerve is the largest nerve in the body.
• Sciatica pain is typically felt from the low back to behind the thigh and radiating down below the knee.
• Treatments for sciatica depend on the underlying cause and the severity.

The good news is that most sciatic nerve pain resolves. Only if the pain is intractable or if there is a progressive neurologic deficit are more aggressive surgical measures needed.

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