Sciatic Nerve Pain
Sciatic Nerve Pain.When it pulls painfully from the back to the leg, the sciatic is usually responsible. This colloquial term summarizes various complaints that emanate from the Sciatic Nerve Pain. Medically correct, the phenomenon is called sciatica. The cause may be, for example, a herniated disc or an inflammation. Read more about the causes, symptoms and treatment of ischialgia and why sciatica does not like sitting for a long time and how to prevent it.
Sciatic Nerve Pain Quick Overview
- What is sciatica? Damage to the Sciatic Nerve Pain with pain that usually radiates to the leg. Doctors speak of sciatica.
- Symptoms: tingling , electric shock-like or pulling pain, numbness, paralysis
- Treatment: depending on cause and severity. Therapeutic options include medication, surgery, physiotherapy, heat treatments, massages etc ..
- Causes: herniated disc , vertebral injuries , articular rheumatism, inflammation, abscesses, bruising, tumors, infections etc.
- Prognosis: With timely, correct treatment, the chances are good that the symptoms completely heal.
Sciatic Nerve Pain Symptoms
The Sciatic Nerve Pain is the thickest nerve in the human body. It runs on the back of the thigh and branches at the level of the knee in both of his lower leg branches, the peronaeus nerve (peroneal nerve) and the Tibial Nerve (tibial nerve). It supplies the muscles in the leg and, with its sensory components, sends sensations from the lower extremities to the central nervous system.
The sciatica can cause creeping or sudden discomfort. Doctors refer to the typical Sciatic Nerve Pain as neuropathic pain . Many patients express themselves more vividly: for example, sciatica symptoms should be “like an electric shock” or “ants tingling in the leg”. In addition, numbness and paralysis may occur.
It is also very characteristic that the pain radiates . One then speaks of radicular (originating from the nerve root) pain . That’s what differentiates the sciatica from a lumbago, for example . This can also occur by unfortunate turning or lifting and manifests itself in sudden back pain. This does not pull in the leg.
If the fibers of the fifth nerve root of the lumbar spine (L5) are particularly affected, the pain runs from the buttocks over the back outer thigh over the outer knee to the front outer lower leg. He can even move on to the ankle. If the first nerve root of the sacrum (S1) is damaged, the Sciatic Nerve Pain will move from the sacrum over the buttocks into the thigh back. The pain continues over the popliteal fossa into the foot .
Sciatic Nerve Pain Treatment: What to do when in pain?
How sciatica pain is best treated depends on the cause, severity and duration of the condition. First and foremost, sciatica treatment is relieved as quickly as possible , especially in new-onset pain . This is to prevent the pain from becoming chronic and developing a so-called pain memory. By this, medical experts understand that the central nervous system will later report pain through “learning effects”, even if there is no longer any cause for it.
Sometimes the body alone manages to heal itself or the affected nerve. Often the pain then lasts for a few days to six weeks.
Tip: For acute complaints, it may be helpful to keep your legs high. You can build a so-called step bed by lying on its back and pushing a pillow or mattress part under your legs so that the lower legs are raised and both hip and knee joints are bent at approximately right angles (90 degrees).
If the pain does not improve or is very severe right from the beginning, the sciatica can be treated in three ways: with medication, other conservative therapies (physiotherapy, etc.) and surgery.
Sciatic Nerve Pain Medicinal Treatment
Sciatica pain can be alleviated with analgesics. The attending physician is usually guided by the World Health Organization (WHO) Pain Management Level Scheme. This scheme consists of the three stages:
- Non-opioid analgesics such as paracetamol , ibuprofen or diclofenac
- weak opioid analgesics (such as tramadol ) in combination with non-opioids
- strong opioid analgesics (eg morphine , buprenorphine or fentanyl ) in combination with non-opioids.
First, it is attempted to alleviate the sciatica pain with non-opioid analgesics. If they are not effective, the doctor may prescribe weak opioids. Strong opioids are used only in the most severe, difficult-to-treat pain.
Note: Opioids are very effective painkillers. But they can have life-threatening side effects and make them dependent. Therefore, they should be used with caution and under medical supervision.
Sometimes the cause of sciatica can also be specifically treated with medication. Then one speaks of a specific sciatica therapy :
For example, if an infection triggers the pain, the doctor may prescribe antibiotics(against bacteria) or antivirals (against viruses). Antibiotics may also be needed in case of complications, such as a collection of pus that presses on the Sciatic Nerve Pain.
Sciatic Nerve Pain Further conservative treatment
In addition to medicines, there are other conservative (non-operative) treatment options for sciatica. Thus, physiotherapy can relieve the Sciatic Nerve Pain and improve the prognosis in the long term. Depending on the method, it can loosen strained muscles, stabilize and strengthen the spine and correct any false and protective posture.
For example, exercise therapy (physiotherapy, back exercises ), heat treatments or massages are used. The therapist will select appropriate treatments for each patient.
Another important approach of so-called multimodal treatment is behavioral therapy . It should help the patient to cope better with the symptoms. In addition, it is intended to prevent the patient being overprotected and less moved for fear of sciatica pain. This endangers long-term treatment success. In modern sciatica treatment, the behavioral approach therefore plays an important role.
Note: Bed rest may be advisable for acute pain. But to prevent future sciatica complaints, sufferers should move a lot. So it is advisable, for example, in desk work to get up every now and then and do light gymnastics (back exercises, etc.). This relieves and strengthens the back and the intervertebral discs.
Sciatic Nerve Pain Operative treatment
Rarely, sciatica requires surgery. This may be the case, for example, if a herniated disc causes serious discomfort (such as defecation, paralysis, or severe pain that is difficult to treat). Sometimes the sciatica is also the result of a narrowing of the spinal canal in the lumbar region (lumbar spinal canal stenosis ). Then an operation may also be useful.
Usually such operations are performed minimally invasive today. The surgeon does not make a big cut to have a direct view of the area to be operated on. Instead, he makes several small cuts, through which he introduces fine optical and surgical instruments into the body.
Sciatic Nerve Pain examinations and diagnosis
Sciatica can be very painful, but usually disappears by itself within days to weeks. But if you have persistent or recurring symptoms, you should go to the doctor.
In general: If back pain is accompanied by numbness or paralysis in the leg and / or disorders of bowel and bladder emptying, you should urgently consult a doctor!
The doctor initially asked in detail about your medical history ( history ). He may ask the following questions:
- Since when do you have the pain?
- Have the symptoms occurred suddenly and in connection with certain strains?
- How would you describe the pain (eg as shooting or electrifying)?
- Where exactly is the pain? Do you radiate?
- What gives you relief?
- What is your profession?
- Is your daily life affected by sciatica pain?
In the following clinical exam , your doctor will first look at your back and legs. He looks for any malpositions and checks the mobility of the joints, the strength of the muscles and their reflexes. He also tests the touch sensitivity and feel of the legs by stroking the skin and letting you identify the spot where he touched you.
Note: With the so-called Lasègue test, your doctor will check if the nerve roots of the lower spinal cord are irritated. You lie on your back and the doctor raises your stretched leg. If the Sciatic Nerve Pain is trapped or otherwise irritated, pain in the back, which shoots into the leg, occurs halfway up.
In the search for the cause of the discomfort, the physician can perform further examinations, for example a magnetic resonance tomography (MRI or magnetic resonance tomography ) or computed tomography (CT). Such imaging methods are especially important if there is a paralysis or discomfort.
To determine the location and extent of the nerve damage, the physician can use electrodes to measure muscle activity ( electromyography = EMG) and nerve conduction velocity ( electroneurography = ENG).
If Sciatic Nerve Pain inflammation is suspected, your doctor will take your blood sample to determine the level of inflammation and to identify any pathogens (such as Borrelia). It may also be necessary to remove and analyze cerebrospinal fluid ( CSF ). For this, the doctor sticks a needle through the skin of the lower back and pushes it gently up into the spinal canal next to the spinal cord before to remove a small cerebrospinal fluid ( lumbar puncture ).
Sciatic Nerve Pain causes and risk factors
The main cause of sciatica problems is a herniated disc or its precursor, the disc protrusion . But other diseases can also be involved if they press on the nerve roots and fibers of the Sciatic Nerve Pain. These include, for example:
- Vertebral injury
- joint rheumatism
- Inflammation of an intervertebral disc and adjacent vertebral bodies (spondylodiscitis)
- Pus accumulations (abscesses)
- Bruising (hematoma)
Another cause of sciatica irritation may be infection , such as Lyme disease . The bacterial pathogens of this infection (Borrelia) are transmitted by ticks. Even herpes viruses in shingles ( herpes zoster) can cause sciatica problems.
Sciatic Nerve Pain in pregnancy
Back pain is not uncommon in pregnancy. But it is rarely the Sciatic Nerve Pain behind it. Instead, the pain is usually due to pregnancy-related factors such as the growing weight in the stomach and the hormonal loosening of the band structures.
This does not mean, however, that sciatica (similar) complaints during pregnancy should be taken lightly. For example, as a herniated disc or other serious causes in question, affected women should definitely go to the doctor.
If this is actually a sciatica, it is usually treated with physiotherapy. Painkillers are used for the well-being of the unborn baby during pregnancy not or only to a limited extent.
Sciatic Nerve Pain Disease course and prognosis
Decisive for the complaint process with sciatica is the trigger. If therapy is started early, the prognosis for Sciatic Nerve Pain pain is good. If no surgery is required, a good pain therapy in conjunction with timely begun physiotherapy can shorten the course of the disease significantly.
It is important to specifically strengthen your back and abdominal muscles with regular exercises and sports. A strong muscular corset relieves and stabilizes the spine. This can alleviate or prevent back problems.
Patients should also learn back-friendly behavior (such as working at the desk or lifting heavy loads). This can alleviate existing symptoms and prevent new sciatica problems.
In addition, social and psychological factors also influence the course and prognosis of back pain, including sciatica. For example, loneliness, depressed mood and stress can cause or aggravate the symptoms. In addition, they can help make the back pain chronic, and reduce the effectiveness of analgesics. That means:
An intact social life, the support of relatives and friends, good working conditions, a trusting relationship with the attending physician and a positive mood can significantly improve the prognosis for sciatica pain.