How Can a Pain Management Doctor Help Me with My Sciatica?

A pain management doctor can help with sciatica by finding what is pressing on or irritating the sciatic nerve and treating that cause, usually starting with nonsurgical care. Sciatica is a symptom rather than a diagnosis of its own: pain, weakness, numbness, or tingling in the leg caused by pressure on or damage to the sciatic nerve.

The pain usually affects one side and can get worse after sitting or standing, at night, or when you cough or sneeze. When it persists, it is worth seeing a pain management doctor.

What Causes Sciatica?

Treatment follows the cause, so identifying it comes first. Possible causes include:

• A slipped or herniated disk: The soft center of a spinal disk pushes through its tougher outer layer. A clinical review of sciatica identifies this as the most common cause.
• Spinal stenosis: A narrowing of the spinal canal that can press on nerves.
• Piriformis syndrome: A muscle deep in the buttock irritates the nerve.
• Spondylolisthesis: One vertebra (a bone of the spine) slips forward over the one below it.
• Pelvic injury, fracture, or tumors: Less common causes that put pressure on the nerve.

How Does a Pain Management Doctor Find the Cause?

The first visit centers on your history and a physical exam. The doctor checks for knee or foot weakness, changes in reflexes, numbness, and pain when your straightened leg is lifted, known as the straight-leg raise test. Before the visit, it can help to note where the pain starts, where it travels, and what makes it worse. Imaging is not always needed at the first visit: the clinical review notes that pain lasting 6 to 8 weeks despite conservative (nonsurgical) care warrants imaging, usually magnetic resonance imaging (MRI), and that signs of nerve damage call for an MRI right away.

What Nonsurgical Treatments Can Help?

Unless a nerve is severely compressed, most sciatica cases are best managed without surgery. A plan may include:

• Medication: A short course of nonsteroidal anti-inflammatory drugs, muscle relaxants, or medicines that calm nerve pain.
• Physical therapy: An exercise program for the back. Bed rest is not recommended.
• Epidural steroid injections: Anti-inflammatory medicine delivered near the irritated nerve. An injection provides short-term relief in at least half of people who receive it, lasting weeks to months. It does not cure the cause, and risks include infection and nerve root damage.

Surgery to relieve pressure on the nerve is usually a last resort. Sciatica often improves on its own, but it commonly comes back, and depending on the cause it can lead to permanent leg numbness or weakness.

When Should You See a Doctor About Sciatica?

It is time to contact a provider when an episode lasts longer than four weeks or feels different and worse than past back pain. Seek care right away for:

• Unexplained fever with back pain
• Back pain after a severe blow or fall
• Weakness or numbness in the buttocks, thigh, leg, or pelvis
• Loss of bladder or bowel control
• Pain that is worse when lying down or wakes you at night

See a San Antonio Pain Management Doctor for Sciatica

Sciatica can make sitting, sleeping, and getting through a workday harder than they should be. Pain & Spine Physicians of San Antonio offers sciatica treatment built around your diagnosis, which can include medication management, image-guided injections, and physical therapy from our in-house partner, Therapy Associates of San Antonio. To find out how a pain management doctor can help with your sciatica, contact us or call [phonenumber] today.