Summary: Sciatica is often assumed to be a condition or a disease. It is actually a symptom most related to disc herniation. And when that is the case, back pain can become a crisis requiring medical intervention.
Back pain is often dismissed as just another part of life. We know it well here in North Texas, as do folks in other parts of the country. Whether the pain is caused by a long day of working the ranch or hours stuck in the car commuting on I-20, we tend to grit our teeth and bear it. But is that the right way to go?
There is a fine line between discomfort and clinical crisis. Unfortunately, the doctors here at Lone Star see patients every day who waited just a little bit too long to ask for help. We understand the mechanics of the spine. More importantly, we can identify the red flags of nerve involvement – which just happens to be the first step in reclaiming one’s life from back pain. The sooner you come to see us, the sooner we can help you start feeling better.
When to Stop Ignoring the Pain
One of the more interesting aspects of back pain is its diversity. Another way to say it is this: not all back pain is created equal. A pulled muscle creates a dull ache or stiffness that tends to improve on its own. Rest for 48-72 hours is generally enough. But when you are talking about the spine and the problem with structural integrity, the pain feels very different. The body tends to send far more aggressive signals.
These signals are the red flags that tell you it is time to stop ignoring the pain. Here are just four examples:
- Radiculopathy – Radiculopathy is essentially a pinched nerve. It sends sharp pains or electric shock sensations down the leg. The pain can reach the calf or the foot as well.
- Neurologic Deficits – Neurologic deficits, like sudden weakness in the leg or the inability to lift the front of your foot, are signs of a more serious problem involving the spine.
- Paresthesia – Paresthesia is a condition in which you might feel constant numbness or those dreaded pins and needles in one of your extremities.
- Saddle Anesthesia – This curious condition causes numbness in the areas of the body that would normally come in contact with a saddle. Think of the buttocks, inner thighs, etc.
The first three red flags indicate it’s time to see a doctor, but you can wait a few days if necessary. Saddle anesthesia is different. It can point to a rare but serious condition that requires immediate medical care.
Back Pain to Sciatica: The Anatomy of Crisis
One of the reasons we encourage patients to see their doctors if their back pain seems to be spine-related is this: persistent back pain can become sciatica. People tend to be confused, believing that sciatica is a disease or a condition. In reality, it is a symptom in the same way a cough is a symptom of a cold.
Sciatica is pain that radiates along the path of the sciatic nerve. This nerve, which is the largest in the body, runs from the lower back down through the hips and into and down each leg. A number of different conditions can cause sciatica. Disc herniation is the most common cause of sciatica, but there are others:
- Spinal Stenosis – This condition is the result of a narrowing of the bone canal through which the spine runs.
- Spondylolisthesis – This condition occurs when one vertebra slips forward over another.
- Piriformis Syndrome – This condition occurs when a small muscle in the buttocks compresses the sciatic nerve.
The doctors here at Lone Star Pain Medicine are not content to simply write a prescription and send you on your way. Our doctors want to get to the root cause. They want to know the source of sciatica so that it can be treated properly. Treating only the symptom provides temporary relief. But treating the source reveals a path to recovery.
Spinal Cord Stimulation as a Treatment
Treating sciatica for most patients involves a combination of physical therapy and injections. But traditional therapies do not work for every patient. Surgery may be an option in extreme cases, but pain medicine doctors tend to avoid invasive surgery whenever possible. So how do we address sciatica that doesn’t respond to traditional treatments?
One of our options is neuromodulation by way of spinal cord stimulation (SCS). SCS is sometimes referred to as the ‘back pain pacemaker’. Why? Because a small, electrical device is implanted under the skin to deliver continuous electric pulses to the spine.
How It Works
Proper placement of the stimulation device includes thin wires with leads that are placed in the epidural space near the spinal cord. The low-level electrical impulses sent by the device actually interrupt pain signals before they make it to the brain. Think of it as the device whispering to the nervous system, telling the brain that you are feeling a soothing sensation rather than sharp, debilitating pain.
SCS doesn’t work for every patient. But here is the wonderful thing: a patient can try it without committing to it. Put another way, a patient can test drive SCS before a device is permanently implanted in the body.
Tests typically operate on a one-week trial basis. The patient is given a temporary generator that is taped to the back. Temporary leads are inserted and placed. If the device reduces pain and improves mobility, a permanent device can be implanted. But if it does not, the device is returned and the patient and doctor look for a new treatment.
Plenty of Causes, Multiple Treatments
Here at Lone Star Pain Medicine, we have multiple treatments to look at for persistent back pain with sciatica. That is a good thing because there are plenty of causes of sciatica in North Texas. From daily commutes on I-20 to working out in the yard to the normal wear and tear of general life, there is no shortage of triggers.
If you are suffering from persistent back pain with the symptoms of sciatica, we invite you to visit us here at Lone Star. Let our doctors find the source of your pain so that we can develop a treatment plan that will help you feel better.
FAQs
How does sciatica differ from general back pain?
Sciatica is different because it runs along the path of the sciatic nerve. Pain is felt in the lower back, through the buttocks, and down into one or both legs.
When should a patient see a pain management doctor for sciatica?
If pain persists for over 4-6 weeks and is accompanied by weakness or tingling, even after physical therapy and over-the-counter medications, it’s advisable to consult a pain management specialist.
Can epidural steroid injections help with sciatica?
Yes, epidural injections are one recommendation for treating sciatic pain.
Which patients are candidates for SCS?
SCS is generally reserved for patients who have not responded to either traditional therapies or injection therapy.
Can your treatments help me avoid back surgery?
Helping patients avoid surgery is one of our goals. We can’t make any promises, but injection therapies and SCS have an excellent track record of keeping patients out of the operating room.
