Anthony L. Komaroff, M.D.
— DEAR DOCTOR K: My sciatica is so bad I can barely walk. Please help.
DEAR READER: Sciatica is a particular kind of low back pain. It's a persistent aching or burning pain felt along the sciatic nerve. This nerve runs from the spine in your lower back, down through the buttock and into your lower leg. You feel pain (and perhaps numbness or weakness) because your sciatic nerve is compressed or injured.
Most cases of sciatica, and indeed most cases of low back pain, do not have serious causes. What a person with sciatica should do depends a lot on whether this is the first attack of sciatica you have had.
If it is, call your doctor. He or she will make sure you don't have a more serious cause of your sciatica and will prescribe medicine if you need it. The doctor will ask you questions about your symptoms and perform a physical examination of your back and legs. He or she may order imaging tests to help reveal what may be irritating or compressing your sciatic nerve, although this is unnecessary most of the time.
If you've had sciatica before, and it has been checked out and treated by your doctor, you don't necessarily need to see the doctor again. If the new attack feels like past attacks, do the exercises and take the treatments that have worked in the past. (Your doctor can order a refill of any expired medicines.)
Sciatica usually responds well to a brief period of rest and limited activity. (Prolonged bed rest can make sciatica worse.) Start gentle exercises as soon as you can. These will help improve mobility and strengthen your back. (I've put pictures of some exercises on my website, AskDoctorK.com.)
Over-the-counter anti-inflammatory drugs, such as naproxen (Aleve), ibuprofen (Motrin, Advil) or aspirin, can help relieve pain and inflammation. Prescription medications used to treat chronic nerve pain may also help. They include amitriptyline (Elavil) and gabapentin (Neurontin).
I've also had patients respond well to chiropractic manipulation, acupuncture, massage and yoga.
In severe cases, an injection of a long-acting anesthetic with a steroid medication can provide relief. In rare cases, you may need surgery.
Once the pain of sciatica passes (usually within six weeks), these steps may prevent it from returning:
I know from personal experience that it's no picnic when you have back pain. But it should get better if you follow this advice.
Dr.Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.
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