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Conservative care
There are a number of conservative treatment options available to
help alleviate the pain and discomfort of
sciatic pain.
Heat/ice
For acute sciatica pain, heat and ice packs are quite often
the first step to try for relief. Usually ice or heat is
applied for approximately 20 minutes, and repeated every two hours.
Most people use ice first, but some
people find more relief with heat. The two may be alternated.
Medications
Over-the-counter or prescription medications may also
be helpful in relieving sciatica pain. Non-steroidal anti-
inflammatory drugs (NSAIDs) or oral steroids can be used to reduce
the inflammation and pain.
Epidural steroid injections
If the pain is severe, an epidural injection
can be performed to reduce the inflammation. An epidural is different
from oral medications because it injects steroids directly to the
painful area around the sciatic nerve to help
decrease the inflammation that may be causing the pain. While the
effects tend to be temporary (providing pain
relief for as little as one week up to a year), an epidural can
be very effective in providing relief from an acute
episode of sciatic pain. Importantly, it can provide sufficient
relief to allow a patient to progress with a conditioning
program.
Conservative care specialists
Treatment with a physical therapist,
osteopathic physician, chiropractor or physiatrist can be helpful
both to alleviate the painful symptoms and to help prevent future
recurrences of sciatica. These conservative care
professionals can assist in providing pain relief and developing
a program to condition the back.
Surgical treatments
If
the pain is severe and has not gotten better within six to twelve
weeks, it is reasonable to consider spine surgery. Depending on
the cause and the duration of the sciatic pain, one of two surgical
procedures may be considered: a microdecompression (microdiscectomy)
or an open decompression (lumbar laminectomy).
Microdiscectomy (microdecompression)
In cases where the pain is due
to a disc herniation,
a microdiscectomy may be considered after 4 to 6 weeks if the pain
is not relieved by conservative means. Urgent surgery is only necessary
if there is progressive weakness in the legs, or sudden loss of
bowel or bladder control. A microdiscectomy is typically an elective
procedure, and the decision to have surgery is based on the amount
of pain and dysfunction the patient is experiencing,
and the length of time that the pain persists. Approximately 90%
to 95% of patients will experience relief from
their pain after this type of surgery.
Lumbar laminectomy (open
decompression)
If the sciatica is associated with spinal stenosis,
surgery may be offered as an option if the patient’s
ability to maintain a normal level of activity falls to an
unacceptable level. Again, surgery is elective and need only
be considered for those patients who have not gotten better
after conservative treatments. After a lumbar
laminectomy (open decompression), approximately 70% to 80%
of patients experience relief from their pain.
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