help bob

[jaycop4]

HI BOB; I SEE ALOT OF QUESSTION ARE DIRECTED TO YOU AND I HAVE ONE AS WELL. I'M A 43 YOA, FEMALE AND MY CONCERN IS THIS. FOR ABOUT 5 MONTHS NOW I HAVE BEEN HAVING EXTREME PAIN IN MY LOWER LEFT BACK..THE PAIN THEN PROCEEDED TO MY LEFT LEG, SHOOTING PAIN IN MY BUTT,LEG AND LOWER BACK. THE PAIN STOPPED ME IN MY TRACKS.I'VE TAKEN MRI, SPINAL TAP AND MY ORTHOPEDIC SAYS HE DOESNT SEE ANYTHING..NOW I'M TRYING TO A NEUROLOGIST..IF IT'S NOT A HERNIATED DISK WHAT COULD IT BE..I A TIRED OF THE PAIN.I ASK FOR SOMETHING STRONGER BECAUSE THE LORCET 7.5'S ARE NOT WORKING AND THEY WON'T GIVE ME ANYTHING STRONGER I THINK THAT IT'S WRONG, BUT THAT'S ANOTHER STORY...YOU IMPUT IS GREATLY APPRECIATED. THANKS

[BobbHilton]

Hi,  
   First grap a cup of tea or coffee and sit down...I will try to make as short as possible ,
Before I start ,you should be careful with using painkillers which may lead a close harmful circle of addiction.
  In a summary, but you still need to read the rest , whenever a full clinical and imaging search could not find a cause we should think of a "Referred pain" from a nearby Viscera (intra-abdominal, intra-pelvic or rectum ) or simply from the hip!!

  Back to your short post, and because I can't see/examin you I have to clarify few things (Correct me if some thing is wrong)  
1- your description is called or  defined  "sciatica"  where an electric-like or stabbing pain that radiates (goes) from the lower back or buttock into the back/the outside of the thigh or leg.
2- a neuropathic pain "Pain associated with nerve/root irritation"  described like your case,  stabbing, shooting, burning.
3- When sciatica is related to nerve root compression, then position changing, such as twisting or sitting in low chairs often make the pain worse, while  leaning to one side or the other may lessen the pain (does this happen to you?).
4- Woseining of the pain by coughing or sneezing , because that transiently  increase in the pressure across the dura (one of the natural protecting layers covering the spinal cord)
5--in back pains, as in any neurological coditions, we have "red flags" needing a very special attention , tell me if you have any of them (fever, chills, or weight loss, Pain worse at rest or at night, Prior history of cance, chronic infection, trauma, immunocompromised state,  Corticosteroid use..ext)
6-Although, MRI/EMG are the gold standard , but in some cases are not enough esp if the pain is becoming chronic (more than 12 weeks like yours) , so we should think of either  
    -CT-myelography (Though, more invasive diagnostic test, requires a lumbar puncture , spinal tap, and a contrast/dye, but give  significantly more information) as it allow evaluation of nerve roots and their relation to bony anatomy (the tunnel they exit from) that may not be seen with routine MRI.
What are the risks of this procedure? these are the possible risks  
allergy to contrast
infection
bleeding
or  developing  spinal tap headaches afterward  that requires you to lay flat but often resolve within a day or two.
Also, the contrast/dye may occasionally be injected into the wrong place ( the subdural space) decreasing the diagnostic yield of the study (make sure to have it in an experienced/educational center like the CCF).

    -Discography, because some reports suggested that the disc itself may generate pain if damaged without direct nerve root compression!!!  

Though it could be difficult for you to understand the following , but I have no choice but to talk about the anatomy  of the sciatic at least briefly, because its essential to  understand of its possible types of injuries.
   I could say that the sciatic nerve is 2 completely separate nerves in one sheath,or say one dress,coat ..ext (one is on the outside part of the coat, get damaged more often,  and one on the inside part)..they split in the back of the knee , where the outside part curve around the knee to supply the front part of leg and feet while the insde one supply the back of the leg , and sole of the feet
    When the sciatic nerve  leaves the pelvis it takes different routs in different people , but mostely passess below a muscle called "piriformis muscle", which is covered by the gluteus maximus, sorry for my english , meant covered by the big muscle of the butt.
    In some people (less fortunate), the nerve passes through the muscle or, less commonly, above it.
What you should know about all the above  especially the MRI did not show anything?
The answer is ,  the investigations are not complete and does not justify entering a harful circle of painkiller addiction..so talk to your neurologist about the possibilty of
1- a nerve entapment in the neural foramina (the tunnel in each side of a vertebra for the nerve to exit the spine..which is poorly seen by an MRI)..so my require a CT Myelography
2- Discography as I explained above
3- Look for a refered pain from a neaby organs ..for example in  the mid 80s reported that  Endometriosis (tissue that lines the uterus may extend) caused pain like yours which usually starts a few days before menstruation and may or may not stop after menses end.
4- Piriformis syndrome, due to the muscle I mentioned, described in the begining of last century , could compress the nerve and give symptomes like your case with normal MRI!!..its suspected clinically (worse during sitting; or  by internal rotation or abduction and external rotation of the hip all done at the same time while you resist the movements, some  local tenderness in the buttock; soft or no neurologic signs (You cant do it yourself ..you will need a neurologist )
5- A full medical causes list should includ every possibility like, though may not apply to your case  
- a Schwannoma of the nerve which could presents with a slow compression.. here we need an MRI the sciatic nerve itself to find it for possible surgical management.
- In 2005 , Abayev reported a case "Heterotopic ossification (bone) encasing the sciatic nerve leading to neuropathy.
- then Walker in the same year reported a woman performing yoga fell asleep in a head-to-knees yoga position developed sciatic nerve compression...LOL
-This year , a report mentioned that Bone marrow biopsy  may cause a sciatic nerve palsy secondary to a gluteal artery pseudoaneurysm (injured vessel) .
- Sarcoidosis can present with granulomatous lesions of the sciatic nerve

6- Not to forget that people with diabetes or vasculitis could have a nerve infarction
7- If  the hip or sacroiliac joints disease are thought to be the cause after ruling out all the above then , the best is a referal to a physiatrist to do few physical maneuvers  e.g  Patrick's sign and/or  heel percussion. In the former, hip or buttock pain is elicited by internal rotation of the hip with the knee in flexion. In the latter, hip or buttock pain is elicited by percussing the heel while the leg is fully extended

  I hope this is helpful

   Bob  Hilton

[jaycop4]

FIRST OF ALL-THANK YOU!!!!
Now i'm going to try to answer your questions and reply to your comments,but i will be printing your reply and take it with me when i go see a neurologist (which i am finally getting to see on the 23rd) The description you gave is right on..the pain radiates from my lower back through my butt, and down my leg. I only take the pain meds mostly at night, so i suffer alot, like before work, at work. but i feel that when i do get to get out of pain, the pain meds should do the job...i'm on light duty now. i had mri, spinal tap w/ dye..yeah the headache part had me a little nervous, but i didn't get one. i had the mylo-thing done to..nothing so they say.  you gave my the best information and most information any damn (excuse my english) doctor i've seen and that's a blackeye for them i must say...as you stated---i've been leaning to one side for the last 5 months too, can't sit on most surfaces, especially hard ones, it sends a terrible pain through me like hell...and my leg throbbs at night..i just finally got something to help me sleep at night, so yesterday i actually got some sleep. but i think it's because i was so tired. last night i took the pills and i was still up hurting. maybe it will help better tonite.....i don't think that the pills will assist with the pain, but just with sleep..the doctor doesn't think a stronger med will help with the pain i have especially at night...i don't believe him really...i believe that there is something strong enough to calm the pain i have..i could be wrong, but my pain is crazy...thanks, look forward to your reply

[jaycop4]

i knew i was going to forget something

yes, i get pain radiating from butt down leg when i cough,sneeze and yes i hurt worse at night or whenever i lay down