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BRAIN & NERVOUS SYSTEM
Pain

 

Treatment

For most people, sciatica responds well to self-care measures. You'll heal more quickly if you continue with your usual activities but avoid what may have triggered the pain in the first place. Although resting for a day or so may provide some relief, prolonged bed rest isn't a good idea. In the long run, inactivity will make your symptoms worse.

Here are conservative measures that you can take or that your doctor may suggest:

  • Cold packs. Initially, your doctor may suggest using cold packs to reduce inflammation and relieve discomfort. Wrap an ice pack or a package of frozen peas in a clean towel and apply to the painful areas for 15 to 20 minutes at least four times a day.

  •  Hot packs. After 48 hours, apply heat to the areas that hurt. Use warm packs, a heat lamp or a heating pad on the lowest setting. If you continue to have pain, try alternating warm and cold packs.

  • Stretching. Initially, passive stretching exercises can help you feel better and may relieve compression, but avoid jerking, bouncing or twisting.

  • Over-the-counter medications. Pain relievers (analgesics) fall into two categories — those that reduce pain and inflammation and those that only treat pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Motrin, Advil, others) which help alleviate both discomfort and inflammation, are the most helpful for sciatica. Although they can provide real relief, NSAIDs have a "ceiling effect" — that is, there's a limit to how much pain they can control. If you have moderate to severe pain, exceeding the recommended dosage won't provide additional benefits. What's more, NSAIDS can cause side effects such as nausea, stomach bleeding or ulcers. If you take these medications, talk to your doctor so that you can be monitored for problems. In addition, periodically re-evaluate whether you still need NSAIDs. Exercise, stretching, massage and other nondrug treatments can often provide the same benefits without side effects.

  • Prescription drugs. In some cases, your doctor may prescribe an anti-inflammatory medication along with a muscle relaxant. Tricyclic antidepressants, such as nortriptyline (Aventyl, Pamelor) or amitriptyline (Elavil) and anticonvulsant drugs, such as gabapentin (Neurontin), also may be prescribed for chronic pain. They may help by blocking pain messages to the brain or by enhancing the production of endorphins, your body's natural painkillers.

  • Physical therapy. If you have a herniated disk, physical therapy can play a vital role in your recovery. Once acute pain improves, your doctor or a physical therapist can design a rehabilitation program to help prevent recurrent injuries. Rehabilitation typically includes exercises to help correct your posture, strengthen the muscles supporting your back and improve your flexibility. Your doctor will have you start physical therapy, exercise or both as early as possible. It's the cornerstone of your treatment program and should become part of your permanent routine at home.

  • Regular exercise. It may seem counterintuitive to exercise when you're in pain, but the fact is that regular exercise is one of the best ways to combat chronic discomfort. Exercise prompts your body to release endorphins — chemicals that prevent pain signals from reaching your brain. Endorphins also help alleviate anxiety and depression, conditions that can make your pain more difficult to control. What's more, combining aerobics with strength training and exercises that maintain or improve flexibility can help prevent age-related degenerative changes in your back. If you're new to exercise, start out slowly and progress to at least 30 minutes most days. To prevent injury, consider learning proper weight lifting techniques from a certified personal trainer, fitness specialist or physical therapist.

When conservative measures don't alleviate your pain within a few months, one of the following may be an option:

  • Epidural steroid injections. In some cases, your doctor may inject a corticosteroid medication into the affected area. Corticosteroids mimic the effects of the hormones cortisone and hydrocortisone, which are made by the outer layer (cortex) of your adrenal glands. When prescribed in doses that exceed your natural levels, corticosteroids suppress inflammation, thereby relieving pressure and pain. Their usefulness in treating sciatica is a matter of debate, however, and they seem most effective when used in conjunction with a rehabilitation program. In addition, corticosteroids can cause serious side effects, so the number of injections you can receive is limited — usually no more than three in one year.

  • Surgery. This is usually reserved for times when the compressed nerve causes significant weakness or you have pain that gets progressively worse or doesn't improve with other therapies. Surgery is most often performed to remove a portion of a herniated disk that's pressing on a nerve, a procedure called diskectomy. Ideally, most of the disk is left intact to preserve as much of the normal anatomy as possible. Sometimes a surgeon will perform this operation through a small incision while looking through a microscope (microdiskectomy). Success rates of standard diskectomy and microdiskectomy are about equal, but you're likely to have less pain and to recover more quickly with microdiskectomy. Possible complications for either type of disk surgery include bleeding, infection, injury to the nerves or spinal cord, scarring and the risks of anesthesia. What's more, although you may experience immediate results from disk surgery, it doesn't stop degenerative changes and your pain may recur in time.

 

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
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