I have been recently diagnosed with sciatica. I have some difficulty in walking. I am having Tramadol and Paracetamol for pain relief but they are not helping much. Could you tell me the underlying cause? Will I require a walking aid?
As you must be aware by now, sciatica is a term used when a person experiences radiating leg pain due to some pressure on the nerves.
Assessment will include intensity of back pain, intensity of leg pain, the distance you walk without any requirement of analgesic and detailed neurological examination including assessment of motor power, sensory evaluation and evaluation of deep tendon reflexes.
This will then be followed by dynamic x-ray and MRI scan of lumbar spine if required. Depending upon the correlation of clinical examination and investigation results, management can then be formulated.
If you have localized back pain with some radiculopathy symptoms with no other neurological symptoms like numbness, weakness, paresthesias, etc., then you can start with following recommendations for initial period of two to three weeks.
Maintain proper posture of your back while working and sleeping.
If pain is more then you can take a short course of an anti-inflammatory medication which suits you.
Medications for radiating leg pain like Pregabalin, Gabapentin, etc., can be initiated on prescription of a spine surgeon.
You can get physical therapy initially under supervision of a trained physiotherapist and then to continue at home. TENS (transcutaneous electrical nerve stimulation) can be initiated for radiculopathy.
Take adequate calcium and vitamin D intake if levels are low in body.
Ice packs can applied if your pain is acute and also hot fomentation can be done at home.
Analgesic spray for local application can be used and is easily available.
You should avoid lifting heavyweight and acute forward bending in mornings.
We will observe your response to this conservative management protocol for next two to three weeks. If you are not feeling better, then we might have to get some investigations like dynamic x-rays of lower back and few blood tests for evaluation.
Enclose your previous investigation and doctor's prescription. I can see them and advise you accordingly.
The Probable causes:
Investigations to be done:
X-ray LS (lumbosacral) spine - AP (anteroposterior) and lateral (flexion and extension) views.
Avoid lifting heavyweight and acute forward bending in mornings.
.. cause is IVDP (intervertebral disc prolapse) and iliopsoas strain.
I feel that pain could be due to irritation.
I would like to you to do a lot of icing on your back once in every two hours.
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