Dear NP

Dear NP,

I was recently diagnosed with sciatica. What causes it? I have tried numerous medications without any relief. What are some other alternatives for treatment? Will physical therapy help?

Dear Reader,

Sciatica is often caused when a herniated disc or overgrowth of bone (bone spurs) in the lower back puts pressure on a nerve. You might hear this called a “pinched nerve.”

This results in inflammation and pain that can travel from the lower back through the hips, buttocks, and even down the leg. The pain can vary from a mild ache to sharp or burning. It might even feel like an electric shock.

Usually, you’ll only have sciatica pain on one side. Sometimes you may also feel numbness or tingling on that side.

While the pain of sciatica can be quite severe, treatment options are available. You should seek medical care if you have sudden or severe back pain, numbness and weakness in a leg, pain after an injury like a car accident or trouble controlling your bowels or bladder.

Certain people are more at risk for sciatica. As we age, changes in the spine, like herniated discs and bone spurs, are the most common cause of sciatica. Being overweight adds stress to the spine.

A job that requires twisting, lifting, or driving for long periods can cause sciatica. If you sit a lot, you’ll be more prone to sciatica than someone active. Diabetes increases the risk of nerve damage that can result in sciatica.

You can do some things to protect your back and prevent sciatica. These include exercising regularly to keep your back and core muscles strong, maintaining good posture when sitting, and using good body mechanics when lifting.

Other treatments are available for sciatica that hasn’t improved with self-care measures. Some medications that might be used to treat sciatica include anti-inflammatories and corticosteroids. These medications reduce inflammation.

Some antidepressant and anti-seizure medications treat pain by changing how nerves transmit pain. Opioid medications are reserved for severe episodes of pain.

Physical therapy can be used to treat sciatica and prevent future injuries. Exercises are given to correct posture, strengthen the core and improve the range of motion. However, it can take four to six weeks or longer to see improvement with physical therapy.

For more severe cases of sciatica, your healthcare provider might recommend a referral to a specialist. An injection of corticosteroid medication around the nerve responsible for causing pain might help. You can receive up to three injections over a year.

And finally, surgery may be an option. This is usually the last treatment option but can be used to remove bone spurs or parts of a herniated disc that put pressure on the nerves. Generally, surgery is done when sciatica causes severe weakness, bowel or bladder control loss, or pain hasn’t improved with other treatments.

Alternative therapies that have been used to treat sciatica include things like acupuncture and chiropractic. During acupuncture, tiny thin needles are inserted at specific points to relieve pain. Chiropractors make spinal adjustments to restore the motion of the spine and reduce pain.

If you think you have sciatica and aren’t improving with conservative measures, speak with your healthcare provider about other treatment options.

Dr. Wesley Davis is an Emergency Nurse Practitioner at Crook County Medical Services District and Coordinator of the Family and Emergency Nurse Practitioner program at the University of South Alabama. He encourages readers to send their questions to [email protected]