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HPC | Hertfordshire Pain Consultants

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  • I wanted to write a letter to you because I'm so grateful to you and your team at the pain management clinc. After spending over 15 years with the most horrendous headaches and seeing dozens of different doctors and therapists finally you have managed to get them under control. Thanks you for taking the time to genuinely listen to me and my problems. Much appreciated.

    K. R
    Hertfordshire
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Content

Sciatica

Sciatica is leg pain caused by compression of nerves within the spinal canal. The sciatic nerve passes from the spine into the pelvis then into the buttock, posterior (back of) thigh and down below the knee.

In those between 20 and 50 years old the most common cause is due to disc herniation where the ruptured/protruding segment of the disc presses against the adjacent nerve. An inflammatory chemical released by the ruptured disc can further irritate the nerve root leading to persistence of symptoms even when the disc has repaired itself.

In older age groups it may occur secondary to narrowing as a result of spinal stenosis or spondylolisthesis.

Symptoms

Patients may have disc prolapse without symptoms of sciatica. Sciatica presents with intense pain travelling down the leg in the distribution of the nerve affected.  In common with nerve pain patients will describe burning sensation, pins and needles, and pain in areas of numbness.
Will I recover

Over 80% of people gain recovery within 6 weeks.  If the pain 'centralizes' (that is, it goes out of the limb and more towards the spine) this is a good sign of improvement. Symptoms of numbness or weakness may last longer than the pain.

If an episode of sciatica settles there is about a 90% chance it will not happen again in the next ten years.  If it has resolved and recurs particularly more than once, then it is more likely that further episdoes will occur.

When should I be concerned

Most sciatica gets better, the only situation that is considered an emergency is when there is numbness between the legs or difficulty with bladder or bowel control.

Treatments

This pain often settles after the first few weeks with simple over the counter medications. Specific anti-nerve pain medications such as amitriptylline, gabapentin, pregablin can be useful in resistant cases.

Injection therapy is usually only required if the problem is not settling satisfactorily after an appropriate period of time. The two injection techniques most often employed are :

1. Epidural injections into the space around the nerves in the spine and within the spinal canal.

2. Nerve root canal injections which are more specific to the affected nerve.

Both injection techniques have the same aim, which is to relieve the pain and inflammation in the nerve while natural healing continues. They can be repeated if required. Both methods seem equally safe. Complications are uncommon, but can include infection or damage to nerves or blood vessels

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