Ask the Pharmacist

Q) I have this excruciating burning pain through my buttock and going down my leg. What’s going on and how can I alleviate it?

A) This sounds like a textbook case of what we term sciatica, named after the sciatic nerve (the largest and longest nerve in your body) which runs from the lumbar and sacral plexuses in the lower back through the buttocks and into the thighs where it transmits signals all the way down to the feet.  While sciatica is less common and is often confused with more traditional lower back pain, it is still a condition that we deal with commonly.

It is estimated that between 13 to 40% of us will deal with it at some point in our lives and while the people most likely to be affected are between the ages of 30 to 59, it can happen to either sex and at virtually any age. The key to differentiating sciatica from lower back pain are the very specific symptoms associated with the condition.

Typically people describe sciatica as a shooting pain that follows a path from your lower back, through your buttock and down the back of your thigh and calf. That being said, the pain could be felt only in certain areas along this trail and can vary widely from a mild ache to a sharp burning sensation that can only be described as severe.

For other people, it can feel like an electric shock, numbness, tingling or just manifest itself as weakness. In some cases, you can have mixed sensations such as pain in one area and numbness in another. Typically, sciatica only affects one side of your body.

Sciatica usually occurs due to a change in the tire-like cushions called discs that sit between the bones that make up our spine. If the tough exterior of a disc tears, which can occur from just routine activities (in fact, some people even develop it in their sleep), a jelly-like inner material is released. This is called a herniated or slipped/ bulged/ ruptured disc. This material can either compress the nearby sciatic nerve or cause an inflammatory process that causes the nerve to start sending out pain signals.

More rarely, the nerve irritation can result from a local bone spur, cysts or other growths in the area and diabetes can cause a pain sensation that closely mimics the presentation of sciatica. The good news in all of this is that even for people with the most severe pain, the body is more than capable of fixing itself. The body can, with time, reabsorb the disc material that is causing the symptoms and so the key is controlling pain and having those people affected stay as active as possible. The days of prescribing bed rest are gone as this has been found to be counterproductive (which is not to say you can’t lie down periodically when the pain gets too much to bear).

Most cases of acute sciatica (75%) will respond well to measures you can do on your own and will often resolve to some extent in a few days to a few weeks. Over the counter pain killers such as acetaminophen/ Tylenol or the anti-inflammatories such as ibuprofen/ Advil or Aleve/ naproxen can help dull the pain allowing you to stay mobile. Gentle (which is the key word here) exercise such as walking can help keep your spine strong without further damaging the discs.

Alternating an ice pack (for 15 minutes every hour) with heat (125 minutes every 2 to 3 hours) can provide immediate relief from those shooting pains. Seeing a physiotherapist or a chiropractor can also be very helpful and they should be able to help you learn a series of stretches and core strengthening exercises which should hasten your recovery and decrease the likelihood of a reoccurrence. Try not to sit too much as this increases pressure on the damaged discs risking aggravating the condition further.

There is a great deal of debate as to whether a cortisone injection into the back is really of much benefit and the use of narcotics for sciatica is generally frowned upon as a treatment since its risks exceeds its benefits.

A doctor should be seen if your pain is severe, you lose bowel or bladder control, your pain gets worse despite following these interventions or doesn’t improve within 2 weeks or if you are experiencing weakness (such as a foot drop). Your doctor may prescribe safe and effective treatments designed to settle down the sciatic nerve such as gabapentin, pregabalin or amitriptyline amongst others.

Lastly, for the unlucky 25% who just don’t seem to improve after a few weeks, surgery that removes the material affecting the nerve is generally a safe option that helps 90 plus per cent of those who undergo it.

Once you eventually get through this ordeal, switch your focus to prevention by maintaining a good posture when you sit (knees and hips level, perhaps using a small pillow in the curve of your back to maintain its natural curve), using good body mechanics when you lift and exercising and stretching regularly, with a particular focus on your core.

With effort, and some degree of good fortune, sciatica will hopefully soon become a distant memory.