An Overview of Sciatica and Radiculopathy

Sciatica is a symptom rather than a condition. It is characterized by severe, shooting, burning, stinging pains that run from the lower back, down through the buttock, and down the back of one leg along the sciatic nerve. It usually only affects one side of the body. Although sciatica is typically treated as a condition unto itself, it is actually a symptom of another condition: Radiculopathy.

Radiculopathy is a neuropathy; a condition in which a nerve does not function properly (usually from an injury or a degenerative condition that causes a compressed nerve). Sciatica is the symptom of a Radiculopathy caused by a compressed nerve in the lumbar region of the back. This compressed nerve is usually caused by a bulging or herniated intervertebral disc or a bone spur on a vertebra.

Those most likely to be experience sciatica are those who may have sustained an injury to the lower back, the elderly, those who sit for prolonged periods of time, and persons that are overweight or obese. In more rare cases the nerve can be compressed by a tumor or from complications from diabetes.

What symptoms are associated with sciatica?

As stated above sciatica is characterized by a pain that is described as shooting, burning, and stinging pain that radiates from the lower back, through the buttock and down the back of the leg, typically only affecting one side of the body. Other symptoms include numbness and weakness in the affected leg and foot, and the sensation of the leg being “asleep” is often described.

How is sciatica diagnosed?

Diagnosis begins with discussing your medical history to determine if there had been injuries or age related bone degeneration that could be the cause. The doctor may order x-rays, MRI (magnetic resonance imaging), or a CT (computerized tomography) to get a good view of the bone structure of the lower spine.

 

What treatments are available for sciatica?

Treatment usually begins with NSAIDS (non-steroidal anti-inflammatory drugs) like Ibuprofen (Motrin) and Naproxen sodium (Aleve), non-narcotic analgesics like Acetaminophen (Tylenol) or aspirin, muscle relaxers like Flexeril and Skelaxin.

When these prove ineffective stronger drugs may be used; some of these are Tricyclic antidepressants like Amitriptyline and Amoxapine, and nacotic analgesics like Hydrocodone (Vicodin), and Oxycodone (Percocet).

For more severe cases of sciatica many people may find relief from a nerve block injection. This type of injection is the most effective treatment for sciatica as they block the pain signal to the brain from the affected nerve. These injections consist of a mixture of medications; local anesthetic and corticosteroids.

Nerve block injections for sciatica are an outpatient procedure; they typically take about thirty minutes to perform followed by thirty minutes to one hour of an observation period following the injection to watch for negative side effects.

The procedure is performed with the patient lying on an exam table and the injection is performed with fluoroscope (a type of xray machine) to ensure proper needle placement. The area to be injected is first cleansed with antiseptic solution and then the skin is numbed with a topical anesthetic to ease the sensation of the needle being inserted.

Contrast dye is injected to ensure that the correct nerve is being treated and that the medication is reaching the nerve. The mixture of medications is then slowly injected (this injection may take a few minutes) and the patient typically experiences immediate relief from the local anesthetic. This usually wears off after a day. The steroid medication may take a day or two before the effect is felt but then the relief will last anywhere from several days to several weeks. Full benefit is usually not gained until repeated injections have been performed.

Side effects and risk from these injections are very minimal. Slight bruising and bleeding from the injection site is possible as is minor infection, however the risk of infection is minimized if the site is kept clean until it heals, usually just a couple of days.

These injections have proven to be very effective in providing relief and the majority of persons receiving them do experience relief from their pain. Discuss with your doctor to see if these nerve block injections may be right for you.