Sciatica is pain resulting from irritation of the sciatic nerve. Sciatica pain is typically felt from the low back to behind the thigh and radiating down below the knee. The sciatic nerve is the largest nerve in the body and begins from nerve roots in the lumbar spinal cord in the low back and extends through the buttock area to send nerve endings down the lower limb. While sciatica is most commonly a result of a disc herniation directly on the nerve, any cause of irritation or inflammation of this nerve can reproduce the symptoms of sciatica. These causes include irritation of the nerve from adjacent bone, tumors, muscle, internal bleeding, infections, injury, and other causes.

Sciatica causes pain, burning sensation, numbness, or tingling radiating from the lower back and upper buttock down the back of the thigh to the back of the leg. Severe sciatica can make walking difficult if not impossible. Sometimes the symptoms of sciatica are aggravated by walking or bending at the waist and relieved by lying down. Sciatica is diagnosed with a physical exam and medical history. The typical symptoms and certain examination maneuvers help your doctor in diagnosing sciatica. Sometimes, x-rays, films, and other tests, such as a CAT scan or MRI scan and electromyogram, are used to further define a cause of sciatica.

Treatments for sciatica have traditionally advocated bed rest. To study the effectiveness of bed rest in patients with sciatica bad enough severity to justify treatment with bed rest of two weeks, researchers in the Netherlands led by Dr. Patrick Vroomen randomly assigned 183 such patients to bed rest or, alternatively, to watchful waiting for the same period of time. In analyzing the outcome, both primary and secondary measures were examined. The primary outcome measures were the global assessments of improvement after two and twelve weeks by the doctor and the patient. The secondary outcome measures were changes in functional status and in pain scores, absenteeism from work, and the need for surgical intervention. Neither the doctors who assessed the outcomes nor those involved in data entry and analysis were aware of any of the patients’ treatment assignments.

The results, reported in the New England Journal of Medicine, showed that after two weeks, 64 of the 92 (70%) patients in the bed-rest group reported improvement, as compared with 59 of the 91 (65%) of the patients in the control (watch-full waiting) group. After 12 weeks, 87% of the patients in both groups reported improvement. The results of assessments of the intensity of pain, the bother someness of symptoms, and functional status revealed no significant differences between the two groups. The extent of absenteeism from work and rates of surgical intervention were similar in the two groups.

The researchers have concluded that: “Among patients with symptoms and signs of a lumbrosacral radicular syndrome, bed rest is not a more effective therapy than watchful waiting.” Sometimes conventional wisdom is not as wise as research. Other treatments for sciatica include addressing the underlying cause, analgesic medications to relieve pain and inflammation and relax muscles, and physical therapy. Surgical procedures can sometimes be required for persisting sciatica that is caused by nerve compression at the lower spine. § Source: New England Journal of Medicine.

DID YOU KNOW? Musculoskeletal pain is one of the most frequent complaints reported in health surveys. Around 50% of the population report having musculoskeletal pain in one or more areas for at least one week during the past month. As we age it appears this will only get worse.

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Sciatica is pain resulting from irritation of the sciatic nerve. Sciatica pain is typically felt from the low back to behind the thigh and radiating down below the knee. The sciatic nerve is the largest nerve in the body and begins from nerve roots in the lumbar spinal cord in the low back and extends through the buttock area to send nerve endings down the lower limb. While sciatica is most commonly a result of a disc herniation directly on the nerve, any cause of irritation or inflammation of this nerve can reproduce the symptoms of sciatica. These causes include irritation of the nerve from adjacent bone, tumors, muscle, internal bleeding, infections, injury, and other causes.

Sciatica causes pain, burning sensation, numbness, or tingling radiating from the lower back and upper buttock down the back of the thigh to the back of the leg. Severe sciatica can make walking difficult if not impossible. Sometimes the symptoms of sciatica are aggravated by walking or bending at the waist and relieved by lying down. Sciatica is diagnosed with a physical exam and medical history. The typical symptoms and certain examination maneuvers help your doctor in diagnosing sciatica. Sometimes, x-rays, films, and other tests, such as a CAT scan or MRI scan and electromyogram, are used to further define a cause of sciatica.

Treatments for sciatica have traditionally advocated bed rest. To study the effectiveness of bed rest in patients with sciatica bad enough severity to justify treatment with bed rest of two weeks, researchers in the Netherlands led by Dr. Patrick Vroomen randomly assigned 183 such patients to bed rest or, alternatively, to watchful waiting for the same period of time. In analyzing the outcome, both primary and secondary measures were examined. The primary outcome measures were the global assessments of improvement after two and twelve weeks by the doctor and the patient. The secondary outcome measures were changes in functional status and in pain scores, absenteeism from work, and the need for surgical intervention. Neither the doctors who assessed the outcomes nor those involved in data entry and analysis were aware of any of the patients’ treatment assignments.

The results, reported in the New England Journal of Medicine, showed that after two weeks, 64 of the 92 (70%) patients in the bed-rest group reported improvement, as compared with 59 of the 91 (65%) of the patients in the control (watch-full waiting) group. After 12 weeks, 87% of the patients in both groups reported improvement. The results of assessments of the intensity of pain, the bother someness of symptoms, and functional status revealed no significant differences between the two groups. The extent of absenteeism from work and rates of surgical intervention were similar in the two groups.

The researchers have concluded that: “Among patients with symptoms and signs of a lumbrosacral radicular syndrome, bed rest is not a more effective therapy than watchful waiting.” Sometimes conventional wisdom is not as wise as research. Other treatments for sciatica include addressing the underlying cause, analgesic medications to relieve pain and inflammation and relax muscles, and physical therapy. Surgical procedures can sometimes be required for persisting sciatica that is caused by nerve compression at the lower spine. § Source: New England Journal of Medicine.

DID YOU KNOW? Musculoskeletal pain is one of the most frequent complaints reported in health surveys. Around 50% of the population report having musculoskeletal pain in one or more areas for at least one week during the past month. As we age it appears this will only get worse.

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