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Sciatica


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I suffered with this for about 8 years when I was younger - the result of an injury. After trying many different treatments, I finally found something that worked - spinal decompression. This is a machine that you are strapped to that pulls your hips down and your shoulders up - thereby "stretching" the spine. The machine can be adjusted to different decompression forces and for different times (typically about a minute/stretch). It then releases the pull and rests for a period of time then cycles again. The treatment was administered for about 30 minutes once per week for about 6 sessions - pain gone never to return. I don't know if there is a place with one of these machines in the area but a doctor might be able to tell you. I used the Canadian Back Institute in Toronto at the time.

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First of all, I really sympathize with your pain.

I have had this problem on and off since I was 12...that's 50 years. Please read the following link...now I know why the x-rays never showed a problem with the spine itself. The pain is quite real but being told it's a figment of your imagination is beyond frustrating.

http://us.cnn.com/2013/09/18/health/back-pain-misdiagnosis-shamie/index.html?hpt=hp_bn13

That may be your problem...or not. But at least you are now aware of the possibility and can discuss it.

I'm sorry that I cannot be of further assistance as to the who or where to go.

BTW, I take one Robax Gold a night to keep the muscle spasms away...been doing that for three years now and rarely have a problem any more...knock on wood.

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I can think of 4 people who have sciatica right now and have had it for months. They have tried exercises, acupuncture, chiropractors, massage, Naprocxin and other NSAIDs and 'herbal teas'.......each had limited relief with one or more of these fixes. Some have even gone to surgeons and had MRI's etc. Some of them have gotten relief some are still hobbling around grabbing their sore muscles in thigh and butt.....Just keep asking folks for what helps them...maybe you'll find something. The sooner the better. I know what you're experiencing, had it a couple of times through the years.

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I had a terrible attack of Siatica about 10 years ago. I went to an orthopedic doctor thinking that it was my knee replacement gone bad. He gave me a prescription for 1 regime of Prednozone (spelling). I took a declining number of pills for 5 days and at the end the pain was gone, never to return. I was concerned about taking them since they are steroids, but he said they are only harmful when used long term. It really worked for me.

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My wife's brother (Mexican from Leon) had a bad problem about a year ago. Lower back and down one leg. Took 3 injections(one a day) of Dexabion, in the hip muscle. Said that in 10 minutes he felt better and in 5 days he was perfect. Has not returned. Available for about 250 pesos local pharmacy. If I have thje problem, I plan on giving it a try. Comes as a 3 pak, and has 2 chambers, so need to mix the 2 chambers before adm. Good luck.

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I had terrible sciatic pain starting last Feb. by April I could not longer do much of anything. I visited my Dr. in Feb and we tried meds and PT to no avail. in April he said I had to get an MRI. He looked at the results and said I needed surgery. I interviewed 3 orthopedic surgeons in Guadalajara and chose one. I had surgery in July and I was playing golf again before Christmas. My pain was gone immediately following the surgery, never to return. Of course I had PT and rehab work and now go to the gym 3 mornings each week. There are several potential causes for sciatica. First, see your Dr. If you don't have one here I recommend Dr. Juan Pablo Loza in Chapala. He'll likely tell you to get an MRI. Do it then take it to multiple Ortho docs for analysis and prognosis. If you wish more info contact me via PM.

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What many people call "SCIATICA" can be caused by a great number of things. Each of those ETIOLOGIES(causes) has a different approach to diagnosis and treatment. A thorough medical history and physical exam are merited.

THE FOLLOWING IS A PART OF THE PATIENT INFORMATION that I provide to patients from the current medical literature that I subscribe to. I hope this helps.

CLINICAL EVALUATION — Low back pain is often attributed to disc degeneration, which is the primary target for many diagnostic approaches. However, the importance of imaging findings associated with disc degeneration (osteophytes, disc narrowing, and herniation) remains unclear. Muscular and ligamentous sources of pain may be equally important.

Although the differential diagnosis of low back pain is broad, the vast majority of patients seen in primary care will have "mechanical" or non-specific low back pain, meaning that there is no neoplastic, infectious, or primarily inflammatory cause. Among all primary care patients with low back pain, less than 5 percent will have serious systemic pathology. Although patients are often told a specific diagnosis for their back pain, reproducibility of these diagnoses (ie, muscle spasm, sacroiliac pain, trigger points) among providers is poor .

Diagnostic uncertainty exists even for those with back symptoms and well-described findings on scan, as these findings are common even in subjects without back pain, and may be unrelated to the symptoms. As an example, herniated disks can be identified in significant numbers of CT or MRI low back studies in subjects with no back pain.

When discussing the cause of a patient's back symptoms, up to date clinicians should avoid using terms that imply deteriorating or damaged body parts. Patients may associate such labels with frightening mental images and serious abnormalities. Phrases such as “back strain,” “protruding disc,” and “normal wear and tear” are more acceptable to patients than "ruptured disc" or "degenerative arthritis" ,

History — While it may not be possible to define a precise cause of low back symptoms for most patients, it is important to evaluate three key elements of the history:

  • Is there evidence of systemic disease?
  • Is there evidence of neurologic compromise?
  • Is there social or psychological distress that may contribute to chronic, disabling pain?

The psychosocial history helps to estimate prognosis and plan therapy (eg, self-care versus exercise therapy) Potentially useful items are a history of failed previous treatments, substance abuse, and disability compensation. Screening for depression may be helpful.

Underlying systemic diagnosis — Clues that may suggest underlying systemic disease include:

  • History of cancer
  • Age over 50 years
  • Unexplained weight loss
  • Duration of pain greater than one month
  • Nighttime pain
  • Unresponsiveness to previous therapies

Pain that is not relieved by lying down can be found in patients whose back pain is due to cancer or infection, but is not specific for these conditions. Injection drug use, skin infection, urinary tract infection, or recent fever increase the suspicion of spinal infection. The presence of ankylosing spondylitis is most commonly diagnosed in men under the age of 40.

Sciatica — Evidence of nerve root irritation typically manifests as sciatica, a sharp or burning pain radiating down the posterior or lateral aspect of the leg, usually to the foot or ankle. Pain radiating below the knee is more likely to represent true radiculopathy than proximal leg pain. Sciatic nerve pain is often associated with numbness or tingling. Sciatica due to disc herniation usually increases with coughing, sneezing, or performance of Valsalva maneuver.

Radiculopathy — The clinical presentations of lumbosacral radiculopathy vary according the level of nerve root or roots involved. The most frequent are the L5 and S1 radiculopathies. Patients present with pain, sensory loss, weakness, and reflex changes consistent with the nerve root involved.

Cauda equina — Bowel or bladder dysfunction may be a symptom of severe compression of the cauda equina, which is a medical emergency. Urinary retention with overflow incontinence is typically present, often with associated saddle anesthesia, bilateral sciatica, and leg weakness. The cauda equina syndrome is most commonly caused by tumor or a massive midline disk herniation.

Spinal stenosis — Nerve root entrapment in lumbar spinal stenosis is caused by narrowing of the spinal canal (congenital or acquired), nerve root canals, or intervertebral foramina. This narrowing is usually caused by bony hypertrophic changes in the facet joints and by thickening of the ligamentum flavum. Disc bulging and spondylolisthesis may contribute. Symptoms of significant lumbar spinal stenosis include back pain, transient tingling in the legs, and ambulation-induced pain localized to the calf and distal lower extremity, resolving with rest. This pain with walking, referred to as "pseudoclaudication" or "neurogenic claudication", is clinically distinguished from vascular claudication by the presence of normal arterial pulses.

Although pseudoclaudication is a classic finding, it is relatively uncommon. More common symptoms of spinal stenosis are simply persistent back and leg pain that are relieved by sitting or other spine flexion. Among surgical patients with advanced lumbar spinal stenosis documented on myelogram, however, pseudoclaudication was found to be a more frequent symptom.

Physical examination — In general, the purpose of the physical examination is to identify features that suggest that imaging and/or other evaluations are indicated (algorithm 1), rather than to make a primary diagnosis. A 2010 systematic review found that many of these physical examination tests, when used alone, had poor diagnostic utility for identifying lumbar radiculopathy due to disc herniation

The basic physical examination should include the following components:

  • Inspection of back and posture — Inspection of the patient on physical examination can reveal anatomic abnormalities such as scoliosis (lateral spinal curvature) or kyphosis (spinal curvature with posterior convexity).
  • Range of motion — Range of motion in flexion and extension does not reliably distinguish among pathologic causes, but can provide a baseline to use as an index of therapeutic response. Limited lumbar flexion is not sensitive or specific for diagnosing ankylosing spondylitis.
  • Palpation of the spine — Palpation of the back is usually performed to assess vertebral or soft tissue tenderness. Vertebral tenderness is a sensitive, but not specific, finding for spinal infection. However, the finding of soft tissue tenderness is poorly reproducible among observers.
  • Straight leg raising (for patients with leg symptoms) — The straight leg raise test may be useful to help confirm radiculopathy. Straight leg raising is done with the patient supine. The test is considered positive when the sciatica is reproduced between 10 and 60 degrees of elevation.
  • Neurologic assessment of L5 and S1 roots (for patients with leg symptoms) — For patients suspected of having a disc herniation, neurologic testing should focus on the L5 and S1 nerve roots, since 98 percent of clinically important disc herniations occur at L4-5 and L5-S1

    L5 motor nerve root testing evaluates strength of ankle and great toe dorsiflexion. L5 sensory nerve root damage would result in numbness in the medial foot and the web space between the first and second toe.

    The S1 nerve root is tested by evaluating ankle reflexes and sensation at the posterior calf and lateral foot. S1 radiculopathy may cause weakness of plantar flexion, but is difficult to detect until quite advanced. One strategy is to have the patient raise up on tip-toe three times in a row, on one foot alone and then the other.

    Although ankle reflexes are an important part of S1 nerve root testing, the absence of ankle reflexes becomes increasingly common with age. Among patients without a known pathologic cause of abnormal reflexes, most patients under age 30 have intact ankle reflexes. However, absent reflexes were found in 30 percent of those between ages 61 and 70 and nearly 50 percent of those ages 81 to 90. Unilateral absence of ankle reflexes was found to be uncommon, though, occurring in only 10 percent of those over age 60. Therefore, unilateral absence of an ankle reflex is rare enough to be a clinically useful sign, with a specificity of 89 percent.
  • Evaluation for malignancy (breast, prostate, lymph node exam) — When persistent pain or history strongly suggests systemic disease.
  • Peripheral pulses — Especially in older patients with exercise-induced calf pain to rule out vascular claudication.
  • Nonorganic signs or Waddell's signs — In patients with chronic pain, psychological distress may amplify low back symptoms, and may be associated with anatomically "inappropriate" physical signs. en the favorable prognosis, imaging studies in the first four to six weeks are not necessary, unless there are neurologic findings or a high suspicion of a systemic etiology. Unnecessary imaging studies can expose individuals to radiation without good reason. As an example, gonadal radiation from a two view lumbar spine radiograph is equivalent to radiation exposure from a chest radiograph obtained daily for more than one year.

So further diagnostics and treatments will depend on your physician's findings after a thorough medical history and physical examination.

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I heard this report on this mornings MORNING EDITION of NPR NEWS.

It did bring back to mind the things I learned when I was working at the REHAB INSTITUTE OF CHICAGO's CHRONIC PAIN CLINIC. It was a 30 day clinic run for patients were taught on how to manage pain without medications. I did notice how these techniques (highlighted in this report) actually worked !!!! Medical or surgical intervention may not always be merited no matter how bad that MRI may actually look. Please read the following report.:

http://www.npr.org/blogs/health/2014/01/13/255457090/pain-in-the-back-exercise-may-help-you-learn-not-to-feel-it

More than one in four adult Americans say they've recently suffered a bout of low back pain. It's one of the most common reasons people go to the doctor. And more and more people are being treated for it.

America spends more than $80 billion a year on back pain treatments. But many specialists say less treatment is usually more effective.

In fact, there's evidence that many standard treatments for back pain – surgery, spinal injections and painkillers – are often ineffective and can even worsen and prolong the problem.

Dr. Jerome Groopman agrees with that premise. He suffered back pain for almost 20 years. He was a young marathon runner 32 years ago when back pain struck out of the blue.

"I couldn't run. It was difficult to sleep," he says. "I wasn't confined to bed, but I was hobbling around."

groopman2-davidcarmack-7bfaa42039c37c631i

Dr. Jerome Groopman found that surgery made his back pain worse.

Courtesy of Dr. Jerome Groopman

Groopman, a Harvard cancer specialist who writes about medicine for The New Yorker, wanted the problem fixed – right away. So he found a surgeon who removed a damaged disc, the jelly-like cushioning between each vertebra.

The surgery didn't fix his pain.

Then, one day during brunch at a friend's house, something happened that altered the course of his life.

"I stood up from a chair and just had an explosive electric shock through my lower back," he remembers. "Basically I fell to the floor and couldn't get up."

His previous pain was severe. But this was over the top. Groopman could hardly move.

"I was so desperate after almost three weeks that I found a neurosurgeon and orthopedist who said, 'You have spinal instability. We'll fuse you and in three weeks you'll be playing football.'"

In a spinal fusion, surgeons weld together adjacent vertebrae with a bone graft. It's anincreasingly common operation.

But for Groopman, more surgery made things worse.

"I woke up from the surgery in excruciating pain, and basically could hardly move my legs," he says. "And I remember the orthopedic surgeon coming by and saying, 'Well, I don't know why you're having so much trouble .... But, you know, if it doesn't get better in a few weeks we could reoperate.' "

Some research suggests that one in five patients who have surgery for back pain end up having more surgery. For some, like Jerry Groopman, it doesn't help at all.

There's "good reason to think that we are overprescribing painkillers, overprescribing injections, overprescribing back surgery," according to Dr. Richard Deyo. He is an authority on evidence-based medicine at Oregon Health Sciences University who has studied treatment of back pain.

One reason invasive treatments for back pain have been rising in recent years, Deyo says, is the ready availability of MRI scans. These detailed, color-coded pictures that can show a cross-section of the spine are a technological tour de force. But they can be dangerously misleading.

backpaindisc1-8de575fc383746110e824f0078

This MRI shows a mildly herniated disc. That's the sort of thing that looks abnormal on a scan but may not be causing pain and isn't helped by surgery.

Science Source

"Seeing is believing," Deyo says. "And gosh! We can actually see degenerated discs, we can see bulging discs. We can see all kinds of things that are alarming."

That is, they look alarming. But they're most likely not the cause of the pain.

Lots of people who are pain-free actually have terrible-looking MRIs. And among those who have MRI abnormalities and pain, many specialists question whether the abnormality really the cause of the pain, and whether fixing it can make the pain go away.

Surgery can help for certain conditions, such as a herniated or bulging disc with leg pain calledsciatica. But most age-related back pain usually can't be fixed with surgery.

Research is showing that the pain often has nothing to do with the mechanics of the spine, but with the way the nervous system is behaving, according to Dr. James Rainville of New England Baptist Hospital in Boston.

"It's a change in the way the sensory system is processing information," says Rainville, who is a physiatrist, or specialist in rehabilitation medicine. "Normal sensations of touch, sensations produced by movements, are translated by the nervous system into a pain message. That process is what drives people completely crazy who have back pain, because so many things produce discomfort."

When Does Surgery Help?

Surgery is often indicated for conditions like severe spinal stenosis, herniated discs, tumors, trauma, scoliosis and other spinal deformities. But less than 5 percent of people with back pain are candidates for surgery, according to some research.

  • Herniated discs: Surgery patients get faster relief, especially those who also have sciatica. Without surgery, people usually recover in 2 to 4 years.
  • Spinal stenosis: Usually found in people over 60. Some randomized trials suggest surgery produces better relief for patients with both back and leg pain.
  • Spinal fusion: Four randomized trials in Europe show fusion is no more effective than rehabilitation, but some physicians it can help in very specific cases.
  • Spondylolithsesis (disc slips forward): surgery often helps.
  • Shrunken or dehydrated disc: Definitely not an indication for surgery.

This is a different way of thinking about pain. Normally pain is an alarm bell that says, "Stop what you're doing right now or you may hurt yourself!" But for many people, that pain is a false signal. It's not about looming danger; it's actually caused by hypersensitive nerves.

Rainville says that about 25 percent of patients with acute back trouble get stuck in an endless loop of pain. He thinks this chronic back pain is often due to persistent hypersensitivity of the nervous system.

Genetics may help explain why back pain becomes chronic for that 25 percent. But whatever the underlying cause, Rainville and others have discovered that many of them can learn to ignore their pain.

That process requires around six months of regular visits to a back pain "boot camp," where specially trained therapists gradually increase the intensity of exercises designed not only to increase the strength and flexibility of the back, but to teach patients that it's OK to move normally again.

Janet Wertheimer is a 61-year-old Massachusetts woman who recently completed Rainville's boot camp. She has had severe back pain on and off for 10 years.

One recent morning, therapist Lisa Childs put Wertheimer through her paces, starting with a rotary torso machine that required her to twist her back this way and that against the resistance of a stack of iron plates.

Next she moved to a back extension device. Wertheimer arched her back against the weight stack – by this point in her rehabilitation 100 pounds of weight. It's something most people with chronic back pain couldn't imagine doing.

"Do you feel like you could do five pounds more or 10 pounds?" Childs asks.

"You can try 10 and I'll see what happens," Wertheimer says.

Wertheimer has a sudden twinge in her back. But Childs, who's trained to evaluate these things, says it's OK. Wertheimer is building strength. And along the way, she's learning not to be afraid. "It's learning not to fear the pain, learning that you can live with pain," Wertheimer says. "Understand what that pain is, but then put it aside."

Most patients in Rainville's boot camp and similar programs find that the pain eventually lessens over a few months. Sometimes it even goes away.

For years after his spinal fusion, Groopman was never without back pain. He tried a long list of things without success. Then a friend suggested that he see Rainville.

Given his long search for relief, Groopman was skeptical. But he decided to give Rainville's boot camp a try.

janetwertheimer_20131223_0108edit-0714f3i

"It's learning not to fear the pain, learning that you can live with pain," Janet Wertheimer says. "Understand what that pain is, but then put it aside."

Ellen Webber for NPR

"He was really tough," Groopman recalls. "He said to me, 'You are worshiping the volcano god of pain!' And I thought: 'What is this about?' "

Rainville explains: "In primitive cultures, if you lived near a volcano and the volcano started smoking and looking like something was going to happen, well, it was obvious[ly] because gods were mad at you. And you'd start doing silly things – sacrificing chickens or goats or whatever, thinking that that would appease the gods."

In a strange way, Rainville says, people with chronic back pain do something very similar. They sacrifice parts of their life – playing golf or softball, running, picking up bags of groceries or grandchildren. Patients get so afraid of pain they do anything to avoid it.

"They keep putting things onto this altar, thinking that's going to change the situation," Rainville says.

But it usually doesn't work. Instead, they get more paranoid about any twinge of pain, and all the while they lose strength and flexibility.

Eventually that message sank in with the skeptical Dr. Groopman. "It took about two months for me to really buy in that this was the way to go," he says. "Just let it go. Don't pay attention to it .... And after about nine months, I was basically without any back pain."

It doesn't work that well for everyone. Janet Wertheimer still has some back pain. But she says after graduating from boot camp she can pretty much do anything she wants to – ski, take mountain hikes, walk her dogs.

And the pain? Most of the time, she says, she blocks it out and moves on.

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My sciatic pain was totally excruciating for 2 months. I birthed 3 children with long, very painful labors and it was like one long intense contraction that never ended. I couldn't do anything but lie on the couch with my leg up and moan. Painkillers, muscle relaxants, and anti-inflammatories barely touched the pain. My back did not hurt AT ALL. What I found on internet research was what is called sacroiliac joint dysfunction, and indeed, that area did hurt. Chiropractic, exercises for sciatica (they actually made it worse), cortisone and B12 injections, and acupuncture didn't help at all. MRI showed some bulging discs, but nothing you wouldn't see in an MRI of most people my age. It slowly got better, though it still hurts off and on a year and a half after the initial attack.

What did help was seeing an excellent physiotherpist (i live in Sayulita, so can't recommend anyone in Lakeside), and getting taped. There is a special kind of tape, looks like wide adhesive tape, it was black, think it's called kinetic tape- it gave a huge amount of relief. If you can find anyone in your area who uses this tape and really knows how to apply it (there are very specific ways to tape according to what is wrong), go for it. I also had someone bring down Magnesium gel- magnesium is easily absorbed through the skin and is good for pain relief. Need to rub it in where the pain is originating from- down the sciatic won't help, as the nerve is being compromised from somewhere else.

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I sympathize with your pain. I am a chronic pain patient who has managed this condition for over 25 years. At times I have both sciatica and trigger point inflamation ( I call it infestation, as those little buggers hide deep within the tissues, right alongside the sciatic nerve.)

Can't recommend Dr or hospital, as I have never used either for this. A good acupuncturist and excellent, well informed masseuse can bring great relief.

Never used an acupuncturist Lakeside, but Barbara Rotthaler helped me when things were really, really bad. The weakness and pain were such that I was afraid to get on and off the bus ! So, I walked down to see her in Riberas every week for 3 weeks. She gave exercises and therapeutic massage that had me walking and coping again soon.

I highly recommend her. She definitely is well trained, knows what she is doing and won't make the problem orse, which many less knowledgeable people can do. She will also clearly explain what she can/cannot do for you. At the very least, you will have an hour of blissful, healing touch.

Best of luck to you.

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  • 2 years later...

I get sciatica on occasion and I fix it within a day. Now this may not work for everyone but for me, it does.

I put a tennis ball under my butt, between spine and hip bone and lay on it and roll on it side by side on the floor. Mind you it hurts like a bugger. 

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My sciatica was so bad when I was younger that I had to take massive pain killers an hour before getting out of bed, just to be able to move. Eight visits to the chiropracter pretty much healed me. Recurring attacks are sporadic, and again chiropracty is my answer. Along with four very basic, on-the-floor exercises that take about five minutes altogether, which often preclude any necessity of going to a chiro.

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Lower back pain for over 20 years. Received relief by using a crochet ball wrapped in a sock and laid on it against either side of the spine when the pressure point was felt for 15 seconds (per Bonnie Prudent's book). For over 10 years I had sciatica pain down the right leg including the toes. The pressure points described by Eagles 100 in the butt always gave relief temperley. After arriving here in Ajijic about 10 years ago I started doing yoga at LCS for just plain exercise and after 6 or 8 months the sciatica pain disappeared. Totally pain free for over 8 years. As you will note, many solutions to many different problems. I would always suggest starting with the least invasive remedies. Even very good doctors will often not know if PT or other less invasive measures are the answer instead of surgery. I had a surgeon who refused to operate on me until he was satisfied that other avenues were first given a chance. PT was my answer not surgery in this case. Good luck and good health. 

 

       

  

 

  

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