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Sciatica |
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Sciatica
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.
Related Sites: Treatments Treatments Programs:
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