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Sciatica, Sciatica Symptoms, and Sciatic Nerve pain

 
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Cap Carter
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Joined: 01 May 2003
Posts: 720
Location: Arlington, TX

PostPosted: Mon Apr 16, 2012 10:40 pm GMT +0000    Post subject: Sciatica, Sciatica Symptoms, and Sciatic Nerve pain Reply with quote

Doc, I retired form racing because of Sciatica. I don't like doing drugs (it makes me stupid) but the only other option is under the knife. I really don't like that idea. Being 53 and getting older should I just live with it?
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Scott S
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Joined: 01 May 2003
Posts: 3059
Location: Houston, TX

PostPosted: Tue Apr 17, 2012 6:59 am GMT +0000    Post subject: Reply with quote

Ten Steps to a Painfree Life by Robin McKenzie.
When I had severe neck problems circa 2006 my ortho doctor's PT suggested this book and its very simple exercises and they have kept me moving since. Like many our age, I have deterioration of the spine and its components, but I'd much prefer stretching and exercises to surgery or drugs.
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Masters 60+;

Rocky Hill and Warda Race Director; TMBRA President
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n8ball
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Joined: 27 Feb 2011
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PostPosted: Tue Apr 17, 2012 3:39 pm GMT +0000    Post subject: Reply with quote

OK, I have been dealing with Sciatic issues myself since my injury last spring. I agree with Scott, unless there is a major issue, crushed vertebrae, I would not go under the knife. I have had a great deal of success with books by Dr. John Sarno. Healing Back Pain, Mindbody Solution, and the Divided Mind are fantastic incites into the plague of chronic pain Western society suffers. I would recommend reading a couple of books or trying Scott's routine before I considered surgery. To be honest with you, after reading those books I have a much better understanding about injury, stress, and chronic pain and how they perpetuate each other. I have several friends who have gone through back surgeries and none of them are "better". In fact, at best they are the same and at worst some are worse off than before. Give the books a try. I would rather wait a while and read a $12 book than go under the knife for a surgery that doesn't have a high rate of success. Just Google Tension Myositis Syndrome or Mindbody Syndrome. I have found that I have been suffering with this for years and never knew. After reading the books I am significantly better.

OK, off the soap box. PM me if you want some info on the books.
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Cap Carter
TMBRA Board Member


Joined: 01 May 2003
Posts: 720
Location: Arlington, TX

PostPosted: Tue Apr 17, 2012 6:05 pm GMT +0000    Post subject: Reply with quote

n8ball wrote:
OK, I have been dealing with Sciatic issues myself since my injury last spring. I agree with Scott, unless there is a major issue, crushed vertebrae, I would not go under the knife. I have had a great deal of success with books by Dr. John Sarno. Healing Back Pain, Mindbody Solution, and the Divided Mind are fantastic incites into the plague of chronic pain Western society suffers. I would recommend reading a couple of books or trying Scott's routine before I considered surgery. To be honest with you, after reading those books I have a much better understanding about injury, stress, and chronic pain and how they perpetuate each other. I have several friends who have gone through back surgeries and none of them are "better". In fact, at best they are the same and at worst some are worse off than before. Give the books a try. I would rather wait a while and read a $12 book than go under the knife for a surgery that doesn't have a high rate of success. Just Google Tension Myositis Syndrome or Mindbody Syndrome. I have found that I have been suffering with this for years and never knew. After reading the books I am significantly better.

OK, off the soap box. PM me if you want some info on the books.


Can't PM here here is my e-mail addy

capcarteratgmaildotcom

thanks

But I really did want Doc's opinion.
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The Bike Doc
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Joined: 08 May 2003
Posts: 1371
Location: Corpus Christi and Warda, Texas

PostPosted: Sun May 06, 2012 1:24 pm GMT +0000    Post subject: Reply with quote

Cap:

Work obligations have kept me from getting back to you quickly. Finally, I have had a chance to do some literature review to try to better answer you question.

You have tough predicament. For the readers, sciatica is pain, numbness and/or weakness to the leg from compression of the sciatic nerve either from a herniated (bulging) disc or bone compression. The disability can be mild to significant such as in your case, having to quit riding your bicycle. There have been various treatments used in the past such as steroid and analgesic injections to the nerve where it emerges from the spine, nonsteroidal anti-inflammatory drugs, muscle relaxants, physical therapy, manipulative therapy (chiropractic) therapy, discectomy (surgical removal of the herniated disc with fusion of the spinal vertebra above and below the herniated disc) and mini discectomy which involves only a partal removal of the disc materials to reduce bulging of the involved disc.

Some patients receive benefit from one therapy more than another. Critical analysis of multiple studies using what is called metaanalysis, looking at larger populations rather than a small isolated study, show overall nonsignificant improvement in sciatica symptoms for almost all approaches. What works for one individual may not work for another and for those that there was no benefit their lack of improvement or worsening symptoms, often negate the net improvement effect of those who did benefit.

So it is a tough call for recommending surgery. Before pursuing surgery, look at nonsurgical therapies and start at the dining table. Weight reduction will reduce the compressive load on the spinal column, vertebra and discs thereby reducing the compressive forces on the spine that can aggravate disc herniation and nerve compression. Talk to your primary care doctor about referral to a clinical nutritionist or a program such as Weight Watchers.

Look at adding nonimpact exercise such as swimming to help you increase your calorie burning, as dieting alone, without exercise, has a high failure rate in bringing weight down and keeping it down. Look at riding a stationary recumbent bicycle which will allow you to do nonimpact exercising of your legs without you having to bend over at the waste and further compress your spinal vertebra and discs. If you tolerate the recumbent stationary bicycle, you may be able to graduate to riding a recumbent bicycle or tricycle on the streets (though traditional mountain bikes rule off road). Physical therapy may help give you some relief while you are working on the above issues.

If you fail the above nonsurgical interventions, then consider surgery and visit with your primary care doctor and the orthopedic doctor/neurosurgery doctor. Ask for a review of the literature on the surgery the doctor is proposing with specific focus on long term outcomes. Do some homework looking at published clinical studies through PubMed http://www.ncbi.nlm.nih.gov/pubmed

I have copied four recent reviews of clinical trials and metaanalysis of different modalities of therapy for sciatica that I gleaned from PubMed.

Thanks,

Paul K. Nolan, MD
AKA: The Bike Doc


Radiology. 2011 Aug;260(2):487-93. Epub 2011 May 25.
Comparative prospective randomized study comparing conservative treatment and percutaneous disk decompression for treatment of intervertebral disk herniation.
Erginousakis D, Filippiadis DK, Malagari A, Kostakos A, Brountzos E, Kelekis NL, Kelekis A.
Source
2nd Radiology Department, University General Hospital Attikon, 1 Rimini St, Haidari 12462, Athens, Greece.
Abstract
PURPOSE:
To compare short-, intermediate-, and long-term functional results concerning pain reduction and mobility improvement between conservative therapy and percutaneous disk decompression (PDD) in patients with intervertebral disk herniations.
MATERIALS AND METHODS:
The study received approval from both the university ethics panel and the institutional review board. Patients provided informed consent for the study. Over the past 4 years, two randomized groups of 31 patients with sciatica due to intervertebral disk herniation were prospectively studied and compared with the t test. The control group underwent conservative therapy (administration of analgesics, antiinflammatory drugs, muscle relaxants, and physiotherapy) for 6 weeks. The decompression group underwent fluoroscopically guided PDD. Pain reduction and mobility improvement were recorded at 3-, 12-, and 24-month follow-up on a numeric visual scale (NVS) (range, 0-10).
RESULTS:
The control group had a mean pain score of 6.9 NVS units 1.9 prior to conservative therapy. This was reduced to 0.9 NVS units 2.0 3 months after therapy; however, it increased to 4.0 NVS units 3.4 at 12-month follow-up and further increased to 4.0 NVS units 3.4 at 24-month follow-up. The decompression group had a mean pain score of 7.4 NVS units 1.4 prior to PDD. This was reduced to 3.0 NVS units 2.4 at 3-month follow-up and further reduced to 1.7 NVS units 2.4 at 12-month follow-up and 1.6 NVS units 2.5 at 24-month follow-up. No complications were noted.
CONCLUSION:
When compared with conservative therapy, PDD shows improved amelioration of symptoms at 12- and 24-month follow-up.
RSNA, 2011.
PMID:
21613439

Cochrane Database Syst Rev. 2011 Feb 16;(2):CD008112.
Spinal manipulative therapy for chronic low-back pain.
Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW.
Source
Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, PO Box 7057, Room D518, Amsterdam, Netherlands, 1007 MB.
Abstract
BACKGROUND:
Many therapies exist for the treatment of low-back pain including spinal manipulative therapy (SMT), which is a worldwide, extensively practiced intervention.
OBJECTIVES:
To assess the effects of SMT for chronic low-back pain.
SEARCH STRATEGY:
An updated search was conducted by an experienced librarian to June 2009 for randomised controlled trials (RCTs) in CENTRAL (The Cochrane Library 2009, issue 2), MEDLINE, EMBASE, CINAHL, PEDro, and the Index to Chiropractic Literature.
SELECTION CRITERIA:
RCTs which examined the effectiveness of spinal manipulation or mobilisation in adults with chronic low-back pain were included. No restrictions were placed on the setting or type of pain; studies which exclusively examined sciatica were excluded. The primary outcomes were pain, functional status and perceived recovery. Secondary outcomes were return-to-work and quality of life.
DATA COLLECTION AND ANALYSIS:
Two review authors independently conducted the study selection, risk of bias assessment and data extraction. GRADE was used to assess the quality of the evidence. Sensitivity analyses and investigation of heterogeneity were performed, where possible, for the meta-analyses.
MAIN RESULTS:
We included 26 RCTs (total participants = 6070), nine of which had a low risk of bias. Approximately two-thirds of the included studies (N = 1Cool were not evaluated in the previous review. In general, there is high quality evidence that SMT has a small, statistically significant but not clinically relevant, short-term effect on pain relief (MD: -4.16, 95% CI -6.97 to -1.36) and functional status (SMD: -0.22, 95% CI -0.36 to -0.07) compared to other interventions. Sensitivity analyses confirmed the robustness of these findings. There is varying quality of evidence (ranging from low to high) that SMT has a statistically significant short-term effect on pain relief and functional status when added to another intervention. There is very low quality evidence that SMT is not statistically significantly more effective than inert interventions or sham SMT for short-term pain relief or functional status. Data were particularly sparse for recovery, return-to-work, quality of life, and costs of care. No serious complications were observed with SMT.
AUTHORS' CONCLUSIONS:
High quality evidence suggests that there is no clinically relevant difference between SMT and other interventions for reducing pain and improving function in patients with chronic low-back pain. Determining cost-effectiveness of care has high priority. Further research is likely to have an important impact on our confidence in the estimate of effect in relation to inert interventions and sham SMT, and data related to recovery.
PMID:
21328304

Int Orthop. 2011 Nov;35(11):1677-82. Epub 2011 Jan 15.
The efficacy of coblation nucleoplasty for protrusion of lumbar intervertebral disc at a two-year follow-up.
Zhu H, Zhou XZ, Cheng MH, Shen YX, Dong QR.
Source
Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, People's Republic of China.
Abstract
PURPOSE:
The purpose of this study was to evaluate longer-term efficacy over a two-year follow-up of coblation nucleoplasty treatment for protruded lumbar intervertebral disc.
METHODS:
Forty-two cases of protruded lumbar intervertebral disc treated by coblation nucleoplasty followed-up for two years were analysed. Relief of low back pain, leg pain and numbness after the operation were assessed by visual analogue pain scale (VAS). Function of lower limb and daily living of patients were evaluated by the Oswestry Disability Index (ODI).
RESULTS:
Operations were performed successfully in all cases. Three patients had recurrence within a week of the procedure. Evaluation of the 42 patients demonstrated significant improvement rate of VAS: defined as 66.2% in back pain, 68.1% in leg pain, and 85.7% in numbness at one-week after the operation; 53.2%, 58.4%, 81.0% at one-year; and 45.5%, 50.7%, 75.0% at two-year follow-up. One week after the operation, obvious amelioration occurred in all the patients, but the tendency decreased. Before operation, the mean value of ODI was 68.2 10.9%. The value at one week was 28.6 8.2%; one-year at 35.8 6.5%; and two-years at 39.4 5.8%.
CONCLUSION:
Coblation nucleoplasty may have satisfactory clinical outcomes for treatment of protruded lumbar intervertebral disc for as long as two-year follow-up, but longer-term benefit still needs verification.
PMID:
21240606

Pain Med. 2010 Aug;11(Cool:1149-68.
The efficacy of transforaminal injection of steroids for the treatment of lumbar radicular pain.
Ghahreman A, Ferch R, Bogduk N.
Source
Department of Neurosurgery, John Hunter Hospital, NSW, Australia.
Abstract
BACKGROUND:
Transforaminal injection of steroids is used to treat lumbar radicular pain. Not known is whether the route of injection or the agent injected is significant.
STUDY DESIGN:
A prospective, randomized study compared the outcomes of transforaminal injection of steroid and local anesthetic, local anesthetic alone, or normal saline, and intramuscular injection of steroid or normal saline. Patients and outcome evaluators were blinded as to agent administered.
METHODS:
The primary outcome measure was the proportion of patients who achieved complete relief of pain, or at least 50% relief, at 1 month after treatment. Secondary outcome measures were function, disability, patient-specified functional outcomes, use of other health care, and duration of relief beyond 1 month.
RESULTS:
A significantly greater proportion of patients treated with transforaminal injection of steroid (54%) achieved relief of pain than did patients treated with transforaminal injection of local anesthetic (7%) or transforaminal injection of saline (19%), intramuscular steroids (21%), or intramuscular saline (13%). Relief of pain was corroborated by significant improvements in function and disability, and reductions in use of other health care. Outcomes were equivalent for patients with acute or chronic radicular pain. Over time, the number of patients who maintained relief diminished. Only some maintained relief beyond 12 months. The proportions of patients doing so were not significantly different statistically between groups.
DISCUSSION:
Transforaminal injection of steroids is effective only in a proportion of patients. Its superiority over other injections is obscured when group data are compared but emerges when categorical outcomes are calculated. Over time, the proportion of patients with maintained responses diminishes.
Comment in
Pain Med. 2010 Aug;11(Cool:1141-3.
PMID:
20704666
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Cap Carter
TMBRA Board Member


Joined: 01 May 2003
Posts: 720
Location: Arlington, TX

PostPosted: Tue May 08, 2012 7:25 pm GMT +0000    Post subject: Reply with quote

The Bike Doc wrote:
Cap:

You have tough predicament. For the readers, sciatica is pain, numbness and/or weakness to the leg from compression of the sciatic nerve either from a herniated (bulging) disc or bone compression. The disability can be mild to significant such as in your case, having to quit riding your bicycle. There have been various treatments used in the past such as steroid and analgesic injections to the nerve where it emerges from the spine, nonsteroidal anti-inflammatory drugs, muscle relaxants, physical therapy, manipulative therapy (chiropractic) therapy, discectomy (surgical removal of the herniated disc with fusion of the spinal vertebra above and below the herniated disc) and mini discectomy which involves only a partal removal of the disc materials to reduce bulging of the involved disc.



thanks doc, reading all of your post made my head hurt, but I get the gest.

drugs are not the answer and I really don't want to get cut on, swimining might be a good choice
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