TO TUCKMORE....confused

[opus88]

goodmorning Tuck and everyone
Tuck I am posting this on an open forum because you're knowledge could help my CONFUSION as well as others with same issues.

I have BOTH sciatica and neuropathic pain...to my legs.
My dx from both MRI and BONE SCAN shows, DDD and Facet joint osteoarthritis
I am on gabapentin 2700mg now and oxycontin 20mg

Are sciatica and neuropathic pain from TWO SEPARATE causes?
I'm not clear on the actual scource of either?...I am assuming its nerve entrapment....but thats by my own reading as my doctors are treating the pain(symptom) and have not ever really given me an exact source.

SCIATICA...the gabapentin DOES control this pain, but NOT the neuropathic severe pain in my legs(which again I am assuming are two different issues?)
NEUROPATHIC pain...in back and legs..OXYCONTIN helps alot with the back pain..but does NOT control the severe  leg pain

I hope all this is making sense to you?
bottom line I guess is what I am trying to say is gabapentin works for the sciatica ONLY
but not the severe over all pain in my legs
neither 2700mg of gabapenin nor the 20mg of oxy( I am currently on) seem to have much of an effect on this severe leg pain.
my question is are these two separate issues in you're knowledge?
can the scaitic nerve be impinged as well as more nerves running down the leg OR is the source all the sciatic???
Am I making sense here?
thx

[Tuckamore]

The nerve impingement may be the culprit of your sciatica depending on the level of the impingement.

Sciatica is nerve pain. Nerve pain is called neuropathy. So the answer is yes and no. Because the sciatic nerve is the largest nerve in the body physicians often say you have sciatica rather than lumping it in with neuropathic pain. You can have neuropathic pain in multiple locations of your body and not have sciatica and visa versa even through they are both defined as neuropathic pain because they are both nerve pain. There can be different causes in the different locations that you have nerve pain.

The shooting, burning and electrical pain you describe is classic nerve pain. Severe pain and numbness is also consistent with nerve pain. Severe nerve pain causes disruption from normal which can in turn causes muscle spasms. I have muscle spasms with my sciatica though not every one does. I know the terms can be confusing and I am not the best at explaining it. Sorry.

Gabapentin doesn't always work for all types of neuropathy. For some ppl it isn't effective on sciatica or any nerve pain. As I said earlier, it doesn't touch mine. Narcotics aren't the best treatment for nerve pain. Often tricyclic antidepressants added to the narcotic along with the gabapentin can be more effective.  

Thanks for your concern. I don't have personal problems per say. As I think you know my father (who I care for in my home) has an end stage disease and takes more and more of my time as he deteriorates. Again thank you. You all are important to me and being here helps me more than you can imagine.

[opus88]

I am so sorry ur having (personal problems)...please contact me anytime ok...

I know ur not a physician, however there are times by reading these posts that I believe people that actually have these pains/conditions get to be more knowledgable abt the conditions than most doctors...

I know you can't dx me, all I ask is you're 'opinion' and don't feel like you have to rush with an answer, you're own issues are much more important than any old  "late night wonderings of my mind" are,

to quote you "my sciatica is my neuropathic pain"
this is where I get confused
to me the shooting/burning/electrical pain with a specific path of butt to down a leg is what I think of as sciatica...and the gabapentin does control that electrical/lighting bolt type of sensation.
the feeling throughout my legs of severe pain/numbess/muscle spasm I assumed was what is refferred to as neuropathy..
but as you say if these  two are one in the same..thats interesting as that would mean that gabapentin is only controlling SOME of the pain
and oxycontin NONE of this pain.
I had assumed that sciatica and neuropathy were maybe two separate issues.
(Oh my dx is DDD and nerve impingment (not stenosis) along with facet osetoarthritis)

I thank you so much for you're input..and you please take care.
opus

[Tuckamore]

Hi Opus,

Sorry I am late to your post. Lots of things going on for me right now. I am not an expert as you know. You have asked a very interesting and complex question. It's one that is more appropriate for your physician. But that said I will try to respond with my personal opinion which is based on multiple factors.

I too suffer from sciatica and I do not have your diagnoses. Gabapentin (Neurontin) does not touch my sciatica.

One theory held by most physicians is that there are different pain-generating mechanisms that underlie neuropathic pain therefore the term mixed pain syndrome has been established. Simply put there are often more than just one contributing factor that is producing the sciatica or your chronic pain.

Neuropathy and neuropathic pain basically mean the same thing. Chronic pain that results from damage to the peripheral or central nervous OR pathological changes (disease) of the peripheral or central nervous system is called neuropathy. It is a single term that covers a broad spectrum of conditions that can cause or produce neuropathic pain. Diabetes, failed back surgery, RPS, nerve entrapment and DDD are a few of the conditions that can produce neuropathic pain.

It's complex, even inflammation (or irritation) of the sciatic nerve (the largest nerve in the body) will produce sciatica which is often termed neuropathic pain. Your DDD may be contributing to your sciatica. Is there also some spinal narrowing called stenosis from your DDD?  Neuropathy (neuropathic pain) can result from any type of pain that compresses or impinges on a nerve. I hope I am not be confusing.

All this mumbo jumbo above means your sciatica is neuropathic pain as is mine as is Sally's, Joe's and Sue's. I think your real question is what is causing it. That one I can't answer.  It can be from so many different things. Mine is from sacroiliac joint dysfunction (SIJ) which is located in the gluteal area. The sciatic nerve runs very near that joint. When the SIJ is inflamed the area swells and irritates or also inflames the sciatic nerve causing sciatica or neuropathic pain.  As you have heard me say sciatica is not a disease it is a symptom.
  
I hope this helps you understand the term(s) that your physician is using. The only way you will know is to ask what specifically is the source of your sciatic pain. Given the limited information I have I might guess that there is something in the structure of your spine that may be compressing or irritating the sciatic nerve (again causing neuropathic pain) but that is mere speculation.

I hope I haven't confused you. I almost confused myself!!  I am not the best at explanations. It is my hope that I have helped you understand the terms better and that your understanding will assist you in asking better questions of your physician. If you need something clarified please feel free to ask. Remeber that I am not not a physician or an expert. My personal opinion(s) should not be used in place of a medical consult.  

Peace,
Tuck

[sandee1818]

Tuckamore will be back on soon. She knows a great deal more about this than I and will answer your question as soon as she is back:)