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Vasantha asked...

My GP has diagnosed me with SCIATICA, what is the best treatment?

I'm a 63 year old man who during the last 2 months has pain in my back and the thigh in my left leg. GP has diagnosed SCIATICA and prescibed painkillers and physical excercises, but the pain still persists. Could this be anything other than SCIATICA? If it is SCIATICA, what is the best treatment?

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The answer

The distribution of the pain that you describe is typical of mechanical pressure on one of the many nerves that arises from the lower back. Inactivity results in weakness of the supporting spinal muscles, poor posture, stiffness and pain.  Pain in the back and down into the leg is often referred to as ‘sciatica’, although strictly speaking this term should be reserved for pain arising from direct pressure on the large sciatic nerves.  More commonly, it is the shock absorbing discs and other associated structures around the spine that can cause pressure on the nerve roots as they arise from the back.  Pain which radiates down the leg and is worse when sitting is typical of a discal protrusion.  Treatments are based around physical therapies which include postural changes, mobilisation and strengthening.  Analgesics can be helpful to break the pain/dysfunction cycle but standard painkillers such as paracetamol, co-codamol and ibuprofen are not always adequate to control referred pain into the legs. Prescription medications such as amitriptyline and pregabalin can be helpful in this case. It is always advisable to have a professional assessment to rule out other possible causes for your symptoms.  If you are unwell for any other reason, have persisting night pain or loss of bladder or bowel function, it is very important that you seek medical advice.

 

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