Sciatica

WHAT YOU SHOULD KNOW:

• Sciatica is a condition where there is pain along the sciatic nerve. This occurs when the sciatic nerve is compressed, inflamed (swollen), irritated, or stretched anywhere along its length. Sciatica may be a symptom of other diseases, such as spinal and neurological (nerve) diseases. It may be related to certain activities, poor posture, or physical or psychological (mental) stress. The most common cause of sciatica is a slipped disc in the spine. Other causes include too much use of buttock or leg muscles, being overweight or pregnant, infections, and tumors.
  
  
• Sciatica usually starts in the lower back and goes down the buttocks and thighs. There may be numbness or problems moving or controlling the leg. A simple leg raise test, bone scan, or x-ray may be done to diagnose sciatica. You may also need an electromyography (EMG), myelogram, computerized tomography (CT) scan, or magnetic resonance imaging (MRI). Treatment may include bed rest, lifestyle changes, assistive devices, medicines, massage, surgery, and physical therapy. With treatment of sciatica, you have a greater chance of the condition going away.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

Treatment for sciatica may cause unpleasant side effects. Medicines may cause you to have nausea (upset stomach), vomiting (throwing up), or stomach ulcers (sores). Treatment with an epidural steroid has risks which include incorrect needle placement, and can lead to pain disorders or paralysis. Other risks of this treatment include headaches, leg pain, and blockage of blood flow to the spinal cord (infarction). You may bleed or get an infection if you have surgery. If not treated, your muscles and nerves may become damaged permanently. Problems with moving your leg, controlling your bladder or bowel, or decreased strength may also result. Early diagnosis and treatment of sciatica is very important. Call your caregiver if you have concerns about your condition, medicines, or care.

WHILE YOU ARE HERE:

Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

Activity: At first you may need to rest in bed. Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. As the pain decreases, you may need to start moving or walking to recover faster. Avoid staying in bed for more than two days.

Cold and warm compresses: Ice packs may be first put on your buttocks, thighs, or legs. After applying the cold compress (ice pack), a warm, wet washcloth or a heating pad (turned on low) may then be placed. Alternating cold and warm compresses will help decrease the swelling and pain.

IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.

Medicines: Your caregiver may give you the following kinds of medicines:

• Epidural steroid medicine: In some cases, an epidural steroid medicine may be offered. This is given as a needle in the area of pain. The medicine may include both an anesthetic (numbing medicine) and a steroid which may decrease swelling and relieve pain. You may be offered this medicine if you have a herniated disk, or stenosis. You may also be offered it if there is pressure on a nerve causing your sciatica pain.
  
  
• Medicines for pain, swelling, or fever: You may be given medicines to treat pain, swelling, or fever while you are in the hospital. These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease, a history of bleeding in your stomach, or any other medical problems. Also tell your caregiver about any allergies you have to medicines. Tell your caregiver about all other medicines, herbs, and supplements that you have taken lately.
  
  
• Muscle relaxers: This is medicine to help your muscles relax. When your muscles relax, you may move more easily and have less pain.

Tests: You may need any of the following:

• Blood and urine tests: Samples of your blood or urine are collected and sent to a lab for tests.
  
  
• Electromyography (EMG): Electromyography is a test that measures the electrical activity of your muscles. Your muscles are tested at rest and while you are using them. An EMG test may also check the nerves that control your muscles.
  
  
• Imaging tests:
  
  
  • Bone scan: This is a test to look at your bones. You are given a small, safe amount of radioactive dye in an IV. Pictures are then taken of your bones. Caregivers can look at the pictures for broken bones, infections, or cancer in the bones.
    
    
  • Computerized tomography scan: This test is also called a CT or CAT scan. An x-ray machine uses a computer to take pictures of your hips, thighs, and legs. Before taking the pictures, you may be given a dye through an IV in your vein. The dye helps the sciatic nerve, muscles, or blood vessels show up better in the pictures. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to any of these.
    
    
  • Magnetic resonance imaging: This test is also called an MRI. During the MRI, pictures of your hips, thighs, and legs are taken. Caregivers use these pictures to look for damaged nerves, muscles, bones, or blood vessels. You will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury. Tell your caregiver if you have any metal implants in your body.
    
    
  • Myelogram: This is an x-ray picture of your spinal cord. A shot of dye is put into your spinal column and then x-rays are taken. The dye helps the pictures of the spinal cord and areas around it show up better.
    
    
  • X-rays: These are pictures of the bones and tissues in your back, hip, thigh, or leg. X-rays may show other problems, such as fractures (broken bones).
  
  
• Lumbar puncture: This procedure may also be called a spinal tap. During a lumbar puncture, you will need to lie very still. Caregivers may give you medicine to make you lose feeling in a small area of your back. Caregivers will clean this area of your back. A needle will be put in, and fluid removed from around your spinal cord. The fluid will be sent to a lab for tests. The tests check for infection, bleeding around your brain and spinal cord, or other problems. Sometimes medicine may be put into your back to treat your illness.
  
  
• Nerve conduction tests: This is a group of tests that are done to check how surface nerves and related muscles in the body respond to stimulation. Electrodes with wires or tiny needles are placed on certain areas like the buttocks and legs for these tests.

Treatment options: You may need any of the following:

• Assistive devices: Caregivers may tell you to wear a binder, brace, or corset. They may also tell you to use crutches, a cane, or a walker. You may need to use them until you can put weight on your leg without pain. Using these devices may decrease stress and strain on your lower back and leg muscles. Ask your caregiver for more information about assistive devices and how to use them correctly.
  
  
• Chemonucleolysis: If you have a herniated disk causing your sciatica, special medicines may also help to soften or shrink (make smaller) the hurt disc.
  
  
• Physical therapy: A physical therapist helps you with special exercises. These exercises help make your bones and muscles stronger.
  
  
• Surgery: Surgery may be needed to correct problems such as removing a damaged disc, or a tumor in your spine. This is done to decrease the pressure on the sciatic nerve.
  
  
• Ultrasound therapy: Massaging the swollen or irritated muscle using a therapeutic ultrasound may relieve sciatica.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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