If you have intense pain that radiates down your leg from your low back or buttock, you may have been told that you have sciatica pain. Treatment for sciatica is one of the most common reasons for referral to a pain doctor.
Because of its name, “sciatica” is often misunderstood as meaning a pinched sciatic nerve. However, sciatica is actually just an old medical term (dating back over 500 years!) of radiating pain down the leg, not necessarily a problem with the sciatic nerve itself. A pinched sciatic nerve is sometimes, but not usually, the cause of sciatica pain. This means that the best treatment for sciatica depends on the real source of pain.
Because nerve roots are not the only cause of sciatica pain, it is important to be examined by a pain management physician to make the right diagnosis. Medical imaging like an MRI is often needed to confirm a bulging disc or compressed nerve root, because ordinary X-rays of the low back only show bones, not discs or nerves.
The good news about treatment for sciatica is that in most cases, it will go away on its own with time without surgery. The bad news is, it can take months or even a couple of years, and sciatica pain hurts! A good pain management doctor can help bring that pain under control until the body heals itself.
What kinds of treatment for sciatica actually work?
First-line treatments include physical therapy and oral anti-inflammatory medications. Unfortunately, chiropractic manipulation does not help for nerve root pain that has been present for longer than 3 months. When these options don’t provide enough relief, I often recommend a quick and safe procedure to deliver concentrated medication (similar to cortisone) directly to the source of nerve pain in the low back. This injection works best with real-time X-ray guidance and requires the skills of an experienced physician. Many of my patients are surprised by how good they feel afterward, and I am able to do it comfortably with only local anesthetic. You can to return to work on the same day.
What if it isn’t the nerve root causing sciatica?
As mentioned above, some cases of sciatica don’t come from the nerve root. The spinal cord itself can be compressed by discs, bone spurs, or masses, causing similar symptoms of sciatica pain. Sometimes it really is a pinched sciatic nerve: the piriformis muscle which runs over the sciatic nerve can become tight and compress the nerve. In my practice, treatment for sciatica in these cases uses a new ultrasound technique to see the muscle and nerve, followed by targeted medication to relax the muscle and relieve the pinched sciatic nerve. Many pain management doctors have not yet been trained in this new procedure. There are also some rarer causes of sciatic nerve injury or irritation that I can address in my office.