Sciatica!!!

[Bamaman]

My wife has been under the care of pain management about 15 years. She's had surgery for spinal stenosis, a number of steroid shots (under flouroscope) and a couple of double nerve ablasions. Our observations:

1. Every person with back problems is going thru Physical Therapy--a number of times.
2. We're somewhat afraid of some chiropractor techniques are doing more damage than good.
3. We'd rather use a neurosurgeon than a orthopaedic surgeon.
4. Only accept steroid injections under a flouroscope. Otherwise, the doctor's just guessing where the canal is, and that's not the way to do it.
5. Steroid injections must be done in series of three--a month apart. That's quicker than Medicare wants to pay for. Often, it's the third shot that puts you over the top.
6. If controlled substances are required to relieve your pain, take them exactly as prescribed. Many get relief and don't take their whole prescriptions--bad. Take'em all.
7. Don't worry about getting addicted to the pain medicine. Your main concern should be to get yourself back into society. The meds can very often keep you from being an invalid.
8. If you continue in pain, get yourself to a pain management clinic that's run by an anestesioligist with a fellowship in pain management. They're real deal--not a regular M.D. claiming to be a pain specialist that gives shots.
9. If the pain management is just shots only and no medicine management, go to another clinic. It takes both to get pain relief.

Unfortunately, state regulations are getting tougher because of physicians that are "candy men" prescribing pain meds to those without physical ailments. We're now required to pickup written prescriptions for controlled substances in person, and Medicare is billed about $360 per month for the office visit AND a $120 mental health analysis. And many of our local pharmacies don't even stock controlled substances, and we have to chase around to find the meds.

[splitwdw]

Quote:

Originally Posted by HadEnuff no mention of deep massage. as to your second question, I don't know. I think the better question would be, "why do they need an MRI to start?" I'm hoping that they will evaluate my symptoms and at least come up with a differential diagnosis of the most likely causes, and arrive at a course of action that will include conservative measures to palliate my symptoms and recommend appropriate diagnostic measures to try to pin down a diagnosis.

Because the pain runs down the sciatic nerve from your lower back through the buttock and down the back of your leg. This same pain can be caused by a herniated disc or spinal stenosis or disc disease or a stress fracture and without an MRI they can't tell what/where the problem is. I wouldn't want them to guess if it was me.

[Capwest28]

Quote:

Originally Posted by mystang52 What works for one person doesn't guarantee the same result for someone else. With that disclaimer, FWIW: I had very bad sciatica (diagnosis was spinal stenosis) a few years back. I started a regular swimming regimen and it was like a miracle cure. It wasn't instantaneous. I noticed a little improvement after 2 weeks or so, and it was 4 - maybe even 6 - months before I felt 100% better. I still swim 4 to 5 days a week, partly because I enjoy it and partly because I don't want the sciatica to recur. Something to consider, anyway.

Thanks for this. Just the kick in the sciatic I needed.


Sent from my iPhone using Early Retirement Forum

[HadEnuff]

Quote:

Originally Posted by splitwdw Because the pain runs down the sciatic nerve from your lower back through the buttock and down the back of your leg. This same pain can be caused by a herniated disc or spinal stenosis or disc disease or a stress fracture and without an MRI they can't tell what/where the problem is. I wouldn't want them to guess if it was me.

However, those things can be present and may not be the cause. Which is why symptom evaluation is important, as is developing a differential diagnosis of all of the most likely causes, based upon that.

I'm not saying that an MRI is not important. I just disagree with the premise that you can't start the process without one. I had an MRI nearly 20 years ago and it showed a herniated disc, however it was not the cause of my pain.

[JoeWras]

I have a 30 year history of this.

Since you got it all of the sudden, be conservative. Give it some time. I know you have a lot of pain, but try the exercise and maybe an injection. Your body has a way of healing this. A bulge or herniation can relax and actually shrink if given time.

Exercise saved me -- for 30 years. You see other posters have previously said the same thing. Swimming really helped me.

But, sometimes, your options run out. After almost a year of suffering again, without improvement (only deterioration), I finally had surgery. No fusion, just a laminectomy/disectomy. I was to the point my life was ruined. I could no longer stand for more than 1 to 2 minutes without sitting or laying down. All the conservative stuff failed, but it did work for 30 years previously.

Now that it is done, I wondered why I waited. As far as surgery goes, it was the most conservative back surgery you can have. It has been positively life changing. DO hold off surgery and try other options first, but DON'T rule it out. You will read horror stories on the internet. However, the right candidate with the right surgeon can result in very successful outcomes.

One more thing, I never really had any "back pain" the last 10 years. It has been 100% in legs and butt. In my case (and I've read others' too), if your pain is mostly in the back, you have a better chance of recovery from conservative treatment.

[JoeWras]

Quote:

Originally Posted by HadEnuff However, those things can be present and may not be the cause. Which is why symptom evaluation is important, as is developing a differential diagnosis of all of the most likely causes, based upon that. I'm not saying that an MRI is not important. I just disagree with the premise that you can't start the process without one. I had an MRI nearly 20 years ago and it showed a herniated disc, however it was not the cause of my pain.

Agree.

I held off the MRI for a long time. First of all, insurance wouldn't pay without first trying all the conservative stuff. Second of all, some providers may jump to too aggressive treatment when they get that MRI in their hand.

My first incidence, which sounds a lot like the OP's, solved after 4 months of gentle exercise. Back then, an MRI was brand new and would take an act of congress to get. We were headed in that direction, but my situation resolved, even though an MRI would have probably showed a herniation. Doesn't matter, my body worked it enough to give me the relief I needed for many years.

MRIs are awesome and all, but I think people generally jump to them way too fast. Insurance typically has it right in this case to "force" people into conservative treatment first.

Of course, if you have bowel or bladder issues, etc., that is different.

[HadEnuff]

Quote:

Originally Posted by JoeWras I have a 30 year history of this. Since you got it all of the sudden, be conservative. Give it some time. I know you have a lot of pain, but try the exercise and maybe an injection. Your body has a way of healing this. A bulge or herniation can relax and actually shrink if given time. Exercise saved me -- for 30 years. You see other posters have previously said the same thing. Swimming really helped me. But, sometimes, your options run out. After almost a year of suffering again, without improvement (only deterioration), I finally had surgery. No fusion, just a laminectomy/disectomy. I was to the point my life was ruined. I could no longer stand for more than 1 to 2 minutes without sitting or laying down. All the conservative stuff failed, but it did work for 30 years previously. Now that it is done, I wondered why I waited. As far as surgery goes, it was the most conservative back surgery you can have. It has been positively life changing. DO hold off surgery and try other options first, but DON'T rule it out. You will read horror stories on the internet. However, the right candidate with the right surgeon can result in very successful outcomes. One more thing, I never really had any "back pain" the last 10 years. It has been 100% in legs and butt. In my case (and I've read others' too), if your pain is mostly in the back, you have a better chance of recovery from conservative treatment.

totally agree. I have a friend who is an orthopedic surgeon, and when I had my first episode of lower back issues 30 years ago I hobbled into his office, certain I was headed for the knife. He laughed at me and assured me that I looked better than most of his post-op patients. And he was right, it cleared up with time.

10 years later I had another episode, a little worse, and I did get an MRI and sure enough, I have a herniated disc. When I saw that I was again sure I was headed for the OR. He was unavailable but his partner, who happened to be a dental patient of mine, assured me that his MRI looked way worse, and I always saw him running all over town.

this sciatica thing is brand new. I wouldn't be surprised if it's really a hip... I'm definitely not in a hurry for surgical intervention. We'll see.

[HadEnuff]

update:

Yesterday,I got in with an MD whose practice is centered around pain intervention and management. He is also a board certified anesthesiologist. He's been doing this in my town for over 20 years.
Among his clinical findings:
1. I have lost significant strength in my right leg
2. I have no patellar reflex at all in right leg

He got me set up for an MRI yesterday afternoon, and after the MRI I delivered to his office the DVD with the images. He is seeing me today to give me an injection into the effected nerve, and to go over the MRI findings.
depending upon what he sees, and how I respond to the injection, I may or may not be a candidate for surgical intervention.
In either case, I think I can look forward to having less pain in a day or two.

[Nemo2]

Quote:

Originally Posted by HadEnuff I think I can look forward to having less pain in a day or two.

Good luck! (What exactly is he injecting into the nerve?)

[HadEnuff]

Quote:

Originally Posted by Nemo2 Good luck! (What exactly is he injecting into the nerve?)

Local anesthetic and a steroid. The LA will provide some more immediate relief, while the steroid effect takes a day or two.

[Nemo2]

Quote:

Originally Posted by HadEnuff Local anesthetic and a steroid. The LA will provide some more immediate relief, while the steroid effect takes a day or two.

All the best...please keep us updated with lots of info on positive results!

[HadEnuff]

Quote:

Originally Posted by Nemo2 All the best...please keep us updated with lots of info on positive results!

thanks, I will.

[Carpediem]

Hi HadEnuff,

I've been a member of the forum for a little while now but haven't posted before. But after reading your post, I wanted to share my own sciatica experience with you in case you found it helpful.

I occasionally suffered bouts with lower back pain combined with some pain down my left leg in the early to mid 2000s. It typically would go away in 1-2 weeks.

But in 2011, I woke up with an unusual amount of pain down my left leg. The only position I could get into without feeling intense pain was flat on my back. To make a long story short, all non-surgical options failed and I ended up having an MRI, which revealed a ruptured disc. As a result of the rupture, some pieces of the disc had lodged against the sciatic nerve and the disc causing extreme pain down my leg. I ended up having a Microdiscectomy and I received immediate pain relief and haven't had any pain since.

Just wanted to share my story in case it helps you. Good luck and I hope you feel better soon.

[MRG]

Quote:

Originally Posted by Bamaman My wife has been under the care of pain management about 15 years. She's had surgery for spinal stenosis, a number of steroid shots (under flouroscope) and a couple of double nerve ablasions. Our observations: 1. Every person with back problems is going thru Physical Therapy--a number of times. 2. We're somewhat afraid of some chiropractor techniques are doing more damage than good. 3. We'd rather use a neurosurgeon than a orthopaedic surgeon. 4. Only accept steroid injections under a flouroscope. Otherwise, the doctor's just guessing where the canal is, and that's not the way to do it. 5. Steroid injections must be done in series of three--a month apart. That's quicker than Medicare wants to pay for. Often, it's the third shot that puts you over the top. 6. If controlled substances are required to relieve your pain, take them exactly as prescribed. Many get relief and don't take their whole prescriptions--bad. Take'em all. 7. Don't worry about getting addicted to the pain medicine. Your main concern should be to get yourself back into society. The meds can very often keep you from being an invalid. 8. If you continue in pain, get yourself to a pain management clinic that's run by an anestesioligist with a fellowship in pain management. They're real deal--not a regular M.D. claiming to be a pain specialist that gives shots. 9. If the pain management is just shots only and no medicine management, go to another clinic. It takes both to get pain relief. Unfortunately, state regulations are getting tougher because of physicians that are "candy men" prescribing pain meds to those without physical ailments. We're now required to pickup written prescriptions for controlled substances in person, and Medicare is billed about $360 per month for the office visit AND a $120 mental health analysis. And many of our local pharmacies don't even stock controlled substances, and we have to chase around to find the meds.

Lots of good advice.

I've had sciatica pain and it's no fun. My c-spine gets much worse. I have had two sets of epidurals, one without and one with flouroscope. The one without the scope was an extremely scary event as in I'll never do that again(I should have had others done in 2010 but refused due to fear) and second injection, but the doc didn't do a third as I had some reaction to the steroids. Second time, 15 years later with same doc, the scope was used. No comparison in my experience, less anxiety and unbelievably I could feel the nerve(C6) numbing as he was performing the procedure! In both cases the doc only did 2 of the scheduled 3 injections.

Good luck feeling better. FYI the folks I've known who had the lower disks fixed did have great results.

[HadEnuff]

Quote:

Originally Posted by RollTideRetired Hi HadEnuff, I've been a member of the forum for a little while now but haven't posted before. But after reading your post, I wanted to share my own sciatica experience with you in case you found it helpful. I occasionally suffered bouts with lower back pain combined with some pain down my left leg in the early to mid 2000s. It typically would go away in 1-2 weeks. But in 2011, I woke up with an unusual amount of pain down my left leg. The only position I could get into without feeling intense pain was flat on my back. To make a long story short, all non-surgical options failed and I ended up having an MRI, which revealed a ruptured disc. As a result of the rupture, some pieces of the disc had lodged against the sciatic nerve and the disc causing extreme pain down my leg. I ended up having a Microdiscectomy and I received immediate pain relief and haven't had any pain since. Just wanted to share my story in case it helps you. Good luck and I hope you feel better soon.

Thanks, in fact that is exactly the scenario that the doc suggested my symptoms pointed to.

[JoeWras]

Quote:

Originally Posted by HadEnuff Thanks, in fact that is exactly the scenario that the doc suggested my symptoms pointed to.

Add me to happy after discectomy. It worked great. My pain is reduced 90%. I suspect the remaining 10% is from another disc, the next one down. Different for me was this was a "slow burn" chronic issue, where my pain got worse, slowly, week by week for a period of almost 1 year. No acute incident that I can remember.

If you do try the injection, pay attention to the story above by MRG. Make sure they use flouroscopy to guide the injection. Don't have them do it without it.

[karen1972]

I feel for you. I had sciatica and back issues for 5 years before I ended up having surgery.. It was bad for 6 months (as it takes a long time to get through their stages), it was ok for 4 1/2 years (no sciatica but plenty of times my back was tweaked) and then it just blew out one day and ended up with emergency surgery as I lost almost all feeling in my toes and foot..

I'm pretty sure I tried everything... muscle relaxers, pain killers, chiropractor, message therapy , physical therapy, epidural shots, yoga, pilates.. it all helped a little and depending on how bad it is, it may suffice.. the problem is the doctor just doesn't know, thats the truth of it..so they go through a standard list of steps increasing in aggressiveness until the least costly one that works. 1) drugs and rest 2) therapy 3) epidural 4) surgery . All the therapy I went through was a combination of yoga and pilates...for me Cobra pose and childs pose really helped relieve the pain most of the time.

All I can say is good luck as every person is completely different so what works for one person isn't guaranteed to work for the next.

[HadEnuff]

Here’s the latest:

MRI results were addressed, and indeed I have a large disc extrusion from the L3-4 disc, which is impinging and compressing the nerve root at the L3-L4 position. This is totally consistent with my symptoms. The big question that remains is whether or not the extrusion is still connected to the main portion of the disc. The image is inconclusive in this matter. If it’s completely sequestered, then it is unlikely that PT will rectify my condition without surgical intervention. However, since it is inconclusive, we are going to try 5 weeks of PT, and assuming no steps backwards, see where we are then.

Nerve root blocks hurt like a (edited). I was moaning, panting and squeezing a rubber ball like the sissy I am. However, I did not move, so I get a gold star for that. As promised, significant relief has been achieved, once I stopped shaking, due to the local anesthetic. The steroidal effect will take a day or two. PT starts Monday.

now, it’s time for a(nother) nap

Dan

[mystang52]

One other tip that might help a little bit: don't sit on soft cushy chairs/sofas. If need be, bring in a firm chair to watch TV, or even sit on the floor with a hard back rest.

[HadEnuff]

Update: Pain is very manageable. I have to take some Norco at night to sleep, but daytime all I need is a bit of Advil and Tylenol gets me through the day.
The scary part is the weakness in my right leg. PT is working on it. They want me walking as much as I can, and I like to walk, so I'm walking a few times/day, about a mile each time. I use my 8-iron as a cane.

Assuming no big set-backs, will confer with doc in 3 weeks to consider progress, and how to proceed.