Many people with back pain that radiates down their legs know they’re experiencing sciatica. But what does sciatica actually mean? The term itself is widely misunderstood and so are its treatments, according to Kaliq Chang, MD, double board-certified in interventional pain management and anesthesiology, of Atlantic Spine Center
“Sciatica is commonly used to describe nerve-like pain traveling down the legs, often from compression of the nerves as they exit the spine,” Dr. Chang explains. Every person with sciatica is dealing not only with back pain, but often-excruciating discomfort fanning down the length of one or both legs.
Sciatica accounts for a small proportion – about 5 per cent to 10 per cent – of all lower back pain, despite the fact that up to 85 per cent of working Canadians will suffer from lower back pain at some point. Medical costs for treatment cost the medical system between $6 to $12 billion annually.
“But for those who deal with sciatica, it can be agony,” Dr. Chang says. “Not only are they able to simply ignore the problem, they shouldn’t. Many compare it to a toothache – it hurts like crazy and needs to be fixed.”
Who’s at risk for sciatica?
Anyone can develop sciatica, but it’s more likely in certain people. Risk factors include being older than 45 or being tall; in addition, smokers and those suffering acute mental stress are more prone as well. If your job involves driving – especially when it vibrates the entire body – or heavy lifting, particularly while bending and twisting, sciatica is also more likely.
But several common back conditions can lead to compression of the sciatic nerves, including bulging or herniated spinal discs; spinal stenosis, which is a narrowing of the spinal canal; scar tissue; and spinal bone spurs, Dr. Chang says. Tingling and numbness can join the lower back pain radiating down to the buttocks, hamstring muscle, calf and foot in sciatica.
“Sitting can make the pain feel worse, and just standing or walking can be difficult because of the constant, sharp pain,” he explains. “When sciatica is serious, patients can experience weakness or loss of movement in their leg and foot. A doctor should definitely be consulted.”
Treatment options have evolved
Once a doctor determines sciatica is the cause of a patient’s symptoms – which involves a mix of clinical tests and imaging scans – it’s useful to know how to tackle the problem. In the past, bed rest was often prescribed for sciatica, but this type of passive approach has evolved to include more active treatments, Dr. Chang says.
Conservative, non-surgical sciatica treatments may include applying ice or heat; taking over-the-counter or prescription pain relievers or muscle relaxants; engaging in exercise and physical therapy; or undergoing epidural spine injections.
“Most of the time, non-operative treatments for sciatica ease the terrible pain,” he says. “But if they don’t and the pain doesn’t lessen, surgery can fix the underlying condition prompting sciatica. Surgery is always a last resort, but is considered when significant muscle weakness, loss of bowel or bladder control, or severe pain is involved. Usually, sciatica is temporary and easily treated. But seeing a doctor is crucial.”
Kaliq Chang, MD, is an interventional pain management specialist, double board-certified in interventional pain management and anesthesiology.