Sciatica or sciatic neuralgia is a commoncondition in which one of the spinal nerve roots of the sciatic nerve is compressed resultingin lower back, buttock and leg pain. Sciatic nerve is a large nerve derived from 5 spinalnerve roots: L4, L5, S1, S2 and S3. It runs from the lumbar spine through the buttockdown the leg and the foot on the posterior aspect. There is one sciatic nerve on eachside of the body. Typically, only one side of the body is affected.A typical sciatica pain is described as a sharp shooting pain in the lower back, downthe buttock, thigh and leg on one side of the body. There may also be numbness, burningand tingling sensations. The pain can get
worse with sitting, moving, sneezing, or coughing.The patterns of pain depend on which nerve root is compressed, and follow the dermatomedistribution. The most common cause of sciatica is a herniatedspinal disc. The spinal disc is a soft elastic cushion that sits in between the vertebraeof the spine. With age, the discs become rigid and may crack, the gellike center of thedisc may protrude out and become a herniation outside the normal boundaries of the disc.Disc herniation presses on the nerve root as it exits the spine.In majority of the cases the condition resolves by itself after a few weeks of rest and conservativetreatment. Pain relief, nonsteroidal antiinflammatory
drugs and muscle relaxants may be prescribed.Stretching exercises and physical therapy may be recommended.Surgery may be needed if the pain doesn't go away after 3 months or more of conservativetreatments. The herniated disc may be removed in a procedure called discectomy. Or, in anotherprocedure called laminotomy, part of the bone of the vertebrae may be cut to make room forthe nerve.
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Oral Steroids for Acute Sciatica Due to Herniated Lumbar Disk
Music gt;gt; The JAMA Network. gt;gt; Catherine Dolf: Every day, thousands ofpeople head to their 's office looking for relief from a very common problem. gt;gt; And so if you have any discomfort you tellme. gt;gt; Catherine Dolf: It's called sciatica. gt;gt; Acute sciatica is often disabling, extremelypainful condition felt on the leg. It's usually caused by a ruptured disc in the lumbar area.
gt;gt; We've begun looking at what are other waysto decrease the pain and improve the function more easily for patients with sciatica. gt;gt; Catherine Dolf: There are limited optionsfor treating this painful condition. One of the most common approaches is to prescribethe oral steroid medication called prednisone. gt;gt; But it's never been studied to see if,in fact, it makes a difference. gt;gt; Catherine Dolf: s Harley Goldbergand Andrew Avins from Kaiser Permanente Northern California and coauthors, studied 269 patientswith sciatica. All patients underwent an MRI to confirm that they had a herniated disc.Two thirds were given oral prednisone and
the other third got a placebo. Patients wereassessed for pain and overall function after three weeks and again at one year. gt;gt; People got no better with the prednisonethan they did with the placebo. That is to say, they both got better equally. There wasactually a little bit of improved functional capacity for people that took prednisone. gt;gt; Catherine Dolf: The study appears in JAMA,Journal of the American Medical Association. gt;gt; We also found that patients who took steroidshad more side effects than patients who took the placebo. But most of those side effectswere fairly mild and transient in nature.
gt;gt; Catherine Dolf: The authors say these resultsprovide important evidence about the relative risks and benefits of steroid therapy. gt;gt; We now have guidance. We have information.And we can provide for our patients true, meaningful, and informed discussions aboutthe relative benefits and risks of this kind of therapy for this kind of condition. gt;gt; Catherine Dolf: The JAMA Report Music .