Nov 14, 2015
Sciatica is mainly referred as low back pain along with pain in one of the lower limbs especially below the knee. Both inflammation and compression of sciatic nerve is seen in Sciatica.
Causes: sciatica may be caused by a herniated disc (HD) with or without nerve-root compression at lumbar level (L1-L4); lumbar canal stenosis, foraminal stenosis, tumors or cysts(less often).
Symptoms: sciatic pain i.e. low back pain radiating to one of the lower limb (leg) itself is a main symptom; pain felt below the knee and into the foot and toes; muscle weakness and reflex changes may also be present.
Diagnosis: sciatica is mainly diagnosed by history taking and physical examination. In history taking patient complains pain in lower back and below knee level. On physical examination, STRAIGHT LEG RAISING (SLR) test or LASEGUE'S sign is the most commonly used physical test. In this SLR test, patient is made to lay down straight and asked to raise his leg (without bending the knee) if he complains of increased pain in leg (below knee) then it confirms sciatica.
Non-pharmacological treatment: Rest and bed rest cannot be recommended and patient can do his daily activities.
Pharmacological treatment: Analgesics like Paracetamol and weak opiods for pain relief can be used as long as necessary. But in case of severe pain, strong opiods can be used for a short period. NSAIDS are also not recommended for long term use.
Epidural corticosteroid injections can provide pain relief only for 3-6weeks i.e. for short term effect. Transforaminal periradicular injections (TPIs) are a better approach than Epidural and intradiscal corticosteroid injections. In chronic sciatica, Antidepressants can have an effect on back pain. As sciatica is a neuropathic pain some drugs like Carbamazepine, gabapentin and clonazepam can be used.
Surgery: In recent decades, spinal surgery rate is increased. Indications for surgery include altered bladder function, progressive muscle weakness and opiod-resistant pain intensity (rare).
Physiotherapy includes TENS (transcutaneous electrical nerve stimulation) for relief of pain and Exercise therapy. No evidence of support to use Acupuncture, spinal manipulation and corsets in sciatica.