How to manage sciatica pain?

Patient's Query

Hi doctor,

My brother has been suffering from sciatica for a long while now. He gets flare-ups where he cannot move very much without being in pain. He tried massages from specialists and some cushions, but they do not seem to work very well. He is 26 years old but is stubborn to get help as he feels like there is nothing he can do to help himself. He sometimes gets a swollen back from the slipped disks causing sciatica. He finds that a strong version of deep heat, which I found in a Chinese herbal medicine store, helps for a short while. However, he likes to play games but has had to start playing lying down on the floor as he cannot tolerate sitting on a chair without getting pain. He has also resorted to sleeping on the floor to avoid back pain, with a special pillow to help elevate his legs from the floor.

I wondered what advice I could get on managing his sciatica pain, as he is a mechanic, he needs his mobility to work. Any special pillows or anything that could help him would be great, as I am tired of seeing him in pain. Please help.

Answered by Dr. Atul Prakash

Hello,

Welcome to icliniq.com.

At 26, especially if the pain has been persisting for a long while (5 years as you write) and affecting work and mobility indoors, it is a matter of concern. The only good thing that I gather from the notes is that you mention no weakness or numbness.

Now coming to your issues. Pain with activity restriction is often the primary reason for getting surgery if the symptoms have persisted for more than three months. Before surgery, an MRI (magnetic resonance imaging) is needed to give some insight into why the pain is persistent. Large discs often resolve after causing symptoms, while small and foraminal bulges cause persisting irritation of the nerve root and often fail conservative treatment.

I will recommend that an MRI be done and, in the meantime, take the following tablets.

Take Pregabalin 75 mg twice daily for three to four weeks minimum, tablet Duloxetine 30 mg daily starting dose, and a 40-60 mg maintenance dose. This will help with keeping the pain from becoming chronic and unresponsive.

In addition, you can try directed steroid injection after the MRI is done. Please let me know once the MRI is done and take the tablets regularly. Also, note that Pregabalin makes one feel a bit sleepy, so working as a mechanic may not be advisable. The pillow should keep the knee flexed to relieve the pressure on the nerve.

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