Treatment for sciatica can vary depending on severity. People with chronic pain may be treated with injections. Leading consultant spine surgeon Mr Jaykar Panchmatia discusses what patients with sciatic pain can expect if spinal injections are required.
What is sciatica?
Sciatica is a pain that radiates from your lower back, also known as the lumbar spine, to your buttock and down your leg. The pain can vary widely from a mild ache to an excruciating pain that feels like an electric shock.
What are the symptoms of sciatica?
Mild cases of sciatica often resolve on their own over a few weeks. You should try to stay active. Some of my patients have also reported finding gentle yoga poses and tai chi soothing. If your sciatica wakes you up at night, you may find relief by putting a small, firm cushion between your knees when sleeping on your side; or when lying on your back, placing several firm pillows under your knees. Physiotherapy is very helpful and pain killers can also help manage your symptoms.
In a small number of cases, sciatica can persist for more than a few weeks. If this is the case for you, or if your sciatica is getting worse, and preventing you from carrying out your usual activities, then you should seek medical advice from your GP. Your GP may decide that you need to see a specialist such as a spine surgeon or pain doctor.
What happens if my sciatica needs treating?
The first thing your spine surgeon or pain doctor will do is take a detailed history and examine your spine and the nerves originating from it. After this, he/she may order tests such as an MRI scan of your lumbar spine. The purpose of the MRI scan is to look for conditions that may be causing your sciatica. These include a slipped disc; spinal stenosis, which is caused by narrowing of the part of your spine that nerves travel through; and spondylolisthesis, which is a condition where the bone in your spine slips out of place.
At this stage, your specialist will likely discuss the treatment options that might help relieve some of your symptoms. Juggling a job, visiting the gym or caring for a young child whilst suffering with sciatica is challenging. As a result, in my experience, people often opt for the least invasive procedure that gets them back on their feet as quickly as possible. Spinal injections often fulfil this goal. Your specialist will discuss the possible complications of an injection with you in clinic. Rare complications include infection, allergic reaction and increased pain.
If I choose to have spinal injections, what comes next?
Your specialist will review your scans and, in conjunction with the findings in your history and examination, suggest which injection is most suitable in your case. Factors that influence the type of injection performed include the location of your pain and the goal of the injection. Most injections are performed to relieve your pain but occasionally your surgeon may perform diagnostic injections to identify the source of your pain.
Most patients do not find having an injection very painful. Injections are performed under sedation to minimise pain and your surgeon will use X-ray guidance to minimise any soft-tissue irritation and to ensure that the injection is accurate. Your specialist may also inject a dye, known as contrast, into your spine to confirm the precise location of your injection.
In the case of sciatica, your injection will likely contain a steroid and a long-lasting local anaesthetic. The local anaesthetic provides pain relief around the source of your sciatica. The steroid relieves inflammation in and around the nerves in your spine.
How long does the pain-relieving effect of spinal injections last?
The pain-relieving effects of the injection vary from person to person but can last for many months. This allows your body time to heal from the underlying condition and for you to undertake activities such as physiotherapy and yoga to help strengthen your spine and help the healing process. This also means you can start to resume activities such as visiting the gym, work and childcare within days of the injection.
There are certain circumstances when you need to seek urgent medical advice in A&E. For example, if your sciatica is present in both legs or is accompanied by bowel and bladder symptoms. This is beyond the scope of this article.
Do you have sciatica or similar symptoms? Or maybe you’re looking for spinal injections for pain relief. Speak to Mr Jaykar Panchmatia for expert assistance and advice. Visit his Top Doctors profile here.