The question: I'm a 44-year-old male and I've suffered on and off from sciatica for many years. Lately, I've been experiencing a very painful episode and the muscle relaxant prescriptions I have don't seem to help. What can I do to reduce the pain?
The answer: Sciatica is the term used to describe pain that radiates along the sciatic nerve, which exits from the lower vertebral bones (lumbar spine) and runs from the lower back, through the buttocks and down each leg. When the sciatic nerve is pinched, it can lead to symptoms of pain, burning or numbness.
Often during an episode of sciatica, the common response is to go on bed rest. While this is a natural reaction, prolonged bed rest has been found to potentially increase back pain. Movement allows nutrients to heal the spine and reduces muscle spasms while helping to increase flexibility and improve muscle tone. It's important to avoid high-impact activities that trigger the pain, but continue with your regular tasks and light exercises. In a small number of cases, if the back pain is so severe that you can't move, a short period of rest may be helpful but generally no longer than one to two days.
In addition to keeping active, there are a number of self-care options you can try.
As with any injury, applying warm packs to the affected area can help soothe the muscle pain and relieve tension. For some, applying ice or a bag of frozen peas to the area also helps. As your pain improves, you can start to introduce gentle stretching exercises that can help relieve pressure off the compressed nerve.
Along with these conservative measures, often medication is needed to treat sciatica. Medications that we commonly use include anti-inflammatories, muscle relaxants and in more severe or persistent cases, narcotic pain medication, antidepressants or anti-seizure meds. Over the counter medications such as acetaminophen, ibuprofen or naproxen can be used first and are often effective. Try taking these for the first few days of an acute flare-up at regular intervals rather than just when the pain is unbearable.
In your case your body may have grown accustomed to the prescribed muscle relaxant medication and therefore it is no longer effective for you. It is important to visit your doctor and review this concern. He or she may suggest increasing the dose or switching to a different medication altogether. Your doctor should also make sure your pain is not the result of another condition.
At the same time, you may want to consider physiotherapy as it can help to correct posture and strengthen the muscles in the lower back to take stress off the nerve. Manipulation of the spine by a physiotherapist, chiropractor or massage therapist has been found to be as helpful as taking pain medication.
And when oral medications do not work for sciatica, there is the option of getting a steroid injection into the back. Steroids work to decrease inflammation and irritation when injected into the the nerve root. While initially helpful, keep in mind that the effect of injections can wear off within one to two months.
Finally, in very rare cases, surgery can be considered. If this is the case, your doctor can refer you to an orthopedic surgeon who specializes in spinal surgery.
It's reassuring to note that for most, flare-ups of sciatica will resolve with conservative treatments. This being said however, given that you've experienced sciatica in the past, it is possible for it to recur again in the future.
Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.
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