Doctor working with a patient to deal with sciatic back pain

Sciatic Nerve Pain: Working with Your Doctor

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When Did the Sciatic Nerve Pain Begin?

The acute onset of sciatic nerve pain is most closely associated with a specific episode of trauma to the spine, such as lifting a heavy bag of groceries from the back seat of your car. In contrast, systemic illnesses cause pain that is much more gradual in onset.

People with inflammatory arthritis of the spine (spondyloarthropathy) may have had back stiffness and pain for six months or longer when first evaluated for their spine symptoms.

How Long Does It Last and How Often Does It Occur?

The initial episodes of mechanical low back pain can resolve over days. With successive episodes, the duration of pain can progressively decrease from a month and then to a week although these episodes may be intermittent over time.

The frequency of pain can follow some form of environmental exposure, such as shoveling snow in winter or several hours of weeding the garden in the summer.

For the medical treatment of sciatic nerve pain, the important characteristic is the duration, not the frequency of the pain. As opposed to a short duration of mechanical low back pain, acute low back pain is more persistent. It may last for months, with minimal variation in discomfort.

Where Is It Located and Where Else Do You Feel It?

Most sciatica pain is localized between the lower rib and buttocks, where the spinal curve is greatest. Frequently, the pain starts to one side of the spine and quickly spreads across the low back. The fleshy part of the back is more commonly affected than the bones themselves.

Occasionally, the pain will be present on both sides of the spine, near the “dimples” just above the buttocks, over the sacroiliac joints. Sometimes the location and radiation of pain are very difficult to describe because it is referred pain, that is, it comes from somewhere else.

Pain can move side to side, or up and down the leg. However, the most important facts are where the pain first started and how far the pain has spread.

What Makes It Feel Worse or Better?

Work With Your Doctor To Relieve your SciaticaMechanical sciatic nerve pain disorders improve with rest and worsen with certain activities. Similarly, muscle injuries are aggravated with stretching and are relieved when the muscle is at rest while the muscle is shortened in length. This resting allows healing to take place.

For example, a thirty-two-year-old man picked up a heavy box of papers and experienced the immediate onset of right-sided low back pain. His pain increased with any spine movement forward (flexed) or to the left side.

These motions stretched the injured muscles on the right side of his spine, thereby intensifying the pain. He was most comfortable when resting in bed or standing with a tilt to the right side.

Anything that increases pressure on discs will also increase compression of spinal nerves.

If you have a herniated disc, you will feel increased pain with sitting, sneezing, coughing, or a bowel movement. Disc pressure is reduced when you are standing up.

If you have more sciatica pain standing, then you could have arthritis of the back joints. You probably have less pain when you sit.

When leg pain occurs with standing, spinal stenosis is the most common diagnosis.

Walking for a distance may be associated with leg pain. If you sit down or lean aagainst something with your spine bent forward, your leg pain decreases.

Sarah’s Story

Sarah is a seventy-two-year-old woman who was able to stand and walk with little discomfort but whose pain was worse when she was sitting or lying in bed.

She was frustrated because she was about to take a trip and was worried about sitting on the plane for an extended time.

Why was she frustrated? She was given a diagnosis of spinal stenosis, or so her MRI scan reported.

However, therapy for that problem had not helped. She had been to other doctors who read her report but did not listen to her complaints. Despite the findings in her spine, the cause of her problem was tension in her hamstring muscles.

A gentle stretching exercise program and the addition of a muscle relaxant improved her condition. Her therapy treated her problem not the finding on her MRI report. Alleviating and aggravating factors for acute low back pain often are more complicated than they seem.

Inflammatory arthritis can hurt more when you are not moving and hurt less with walking, bending, and stretching. Others with acute low back pain experience severe pain unless they stay motionless. They may also have other signs of a serious illness such as fever, chills, or weight loss (remember those red flags).

What Time of Day or Night Does Sciatic Nerve Pain Occur?

Systemic disorders, like inflammatory arthritis, are most symptomatic during sleep or in the early morning while getting out of bed. Stiffness and pain are improved with normal movement as the day progresses.

Conversely, people with tumors of the spine have increased pain when lying flat in bed. They usually sit in a chair to sleep, or they may walk around to relieve their pain. Mechanical disorders become more symptomatic with use, and the greatest pain occurs at the end of the day.

What Is the Depth and Intensity Of The Pain?

A wide variety of terms are used to describe pain in general.

Skin disorders cause local burning pain on the surface of the body.

Disorders of the bones, joints, muscles, and ligaments cause a deep, dull ache that is most intense over the involved site.

A cramping pain is associated with reflex contraction of an injured muscle or from a muscle chronically contracted to protect an injured portion of the lumbar spine, like a facet joint.

Pain from nerve compression (radicular pain) has a sharp, shooting, burning quality that follows the distribution of the compressed nerve. This kind of pain is associated with sciatica and is caused by compression of the sciatic nerve.

Other forms of nerve pain occur with direct trauma to the nerve or secondary to changes in the metabolism of the nerve, a situation associated with diabetes. This form of pain has a tingling and crushing component that is unaffected by the physical position of the body but is intensified by touching of the skin supplied by the nerve. The severity of the pain may continue even after the stimulus is gone.

Kidney stones cause a recurrent gripping pain that rises quickly to its greatest intensity in twenty to thirty seconds, lasts one to two minutes, and then quickly resolves.

Throbbing pain is associated with disorders of blood vessels. A tearing sensation is a potential sign of blood vessel injury that may cause loss of blood flow to structures in the lower extremities.

Who Else in Your Family Has Sciatic Nerve Pain?

Most disorders of the lumbar spine are not genetic. However, disc herniations and sciatica occurring in many family members might suggest a relationship between your back and leg pain and family characteristics.

The group of conditions known as inflammatory arthritis of the spine (spondyloarthropathies) has a genetic predisposition and a test could determine if you are at risk. Therefore, it is worth mentioning these disorders to your doctor as part of your family history.

How Does Your Work or Lifestyle Affect It?

Your profession can determine your risk of developing low back pain. Other risk factors aside, heavy lifting and carrying on the job add to the risk for developing mechanical low back pain. The onset of pain while at work has potential implications for qualifying a worker for compensation.

Be sure to tell your doctor if you see a relationship between your job and your back pain. If you sit all day at a computer, you may develop sciatic nerve pain. There’s been lots of talk lately about ergonomics, posture chairs, and mouse pads.

Smoking tobacco and drinking alcohol are implicated in osteoporosis; they weaken the bones in your spine. Alcohol may also limit the use of certain medications used to control pain and inflammation.

Think about the way your back pain affects activities and relationships with the important people in your life.

Perhaps you are unable to participate in your basketball or bowling league or ballroom dancing. Back pain often has a detrimental effect on sexual relationships. When any simple motion increases your pain it is difficult to enjoy sex. Discuss these social and personal difficulties honestly with your physician so he or she can help you in an appropriate way.

Sciatic Nerve Pain – Past and Present Medical History

Your medical history necessarily deals with past and current illnesses. For example, a history of cancer may have great significance in the onset of new back pain. A previous injury, such as slipping and falling on ice, maybe the initiating event in the development of a herniated disc.

A history of diabetes increases the risk of developing sciatic nerve pain. Psoriasis and inflammatory bowel disease are associated with inflammatory arthritis of the spine. Eye inflammation may also be linked with back disorders. Illnesses such as hypertension may limit the use of certain medications because of side effects. Environmental or drug allergies should be mentioned as well.

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