Sciatica treatment: Neurologist or orthopedic?

[Ahntrio3]

I'm in between PCPs right now, but was diagnosed with sciatica recently (at the ER).  They suggested an orthopedic while others insist a neuro is the way go. I'm not sure whom to contact.

Second question: I did schedule a neuro but he can't see me for another 2 weeks.  His office seems unconcerned about my pain so I'm in quandary as to how to hang on.  Is there something I should say to the office when calling?

Your thoughts would be appreciated!  Thanks.

[caregiver222]

The answer is the two professions are complimentary.

Square "one" is what is called "conservative therapy".

This involves learning how to lift properly, avoiding abnormal lifts (or lifting at all for a while) and avoiding riding in a truck or a car without an inflatable cushion. Avoiding lifting is a MUST.

Generally anti-inflammatories are prescribed.

In addition maintaining good hydration is recommended.

And keep glucose levels low because high glucose affects osmolality, which impinges on the nerves.

Next step is most important. A rehabilitative therapist who will demonstrate certain exercises which you must religiously practice. You cannot learn these on the internet or from a video. You will need at least six sessions. If this is not covered by insurance pay for the treatment.

The therapist should be recommended by a physician who will discuss the MRI and make specific recommendations.

Ibuprufin may be taken. The non-prescription dose is 200 mg. Prescription dose is 400 mg. You can safely take 800 mg a day (two prescription pills, with food every 12 hours) for several weeks without harming the liver.  Usually a single 200 mg pill is not enough.

If the pain persists ask the physician to prescribe a TENS device. This produces small electrical impulses that interfere with the pain signals. They work very well. You really need a physician or physical therapist to instruct you on proper use. They work because the human nervous system can only transmit one pain signal at a time. The body senses the small electrical signal from the TENS as "pain" and suddenly the pathway from your spinal nerve is blocked.

Accupuncture works similarly. It is also a good treatment.

Avoid ultrasound because it just irritates the nerve. Many doctors continue to use it.

There is a new treatment in Europe that is based upon injecting ozone in the interstitial spaces. It is being experimentally tried in the United States.

Be very reluctant to undergo a surgical procedure. The operation is called a "laminectomy" and a small segment of cartilidge is removed to permit the nerve to have more space. If you have this procedure done have it done where they do a lot of them.

Usually these problems are chronic in nature, but they come and they go. In other words you may have an intense problem for a week, then it will go away for several weeks.

Oral prednisone will work, but it also causes deterioration of the cartilidge, as well as impacting the immune system. Long term use of prednisone is not desireable. That being said, an acute episode can be relieved by prednisone. When things get bad you may not be able to get out of bed. Discuss this with your physician.

[Dr Vinod]

Hello!

You can consult a neurologist as initial treatment will be more to cure your symptoms of nerve impingement.

Physiotherapy, pain medications, life style changes are different forms of conservative therapy.

When you consider surgery you can follow up with a neurosurgeon or an orthopedician experienced in back problems.

There is nothing to ask till you meet him take intermittent ibuprofen for the pain and use hot fomentation for your lower spine area and start following proper ergonomics.

Take care!