In this article Dr. Tim Speciale discusses that challenges of accurately diagnosing and treating sciatica, surgical options, and non surgical treatments that include Prolotherapy and Stem Cell Therapy.
A recent medical blog reported on the disappointing options for sciatica treatment.1 Reviewing two studies, the author concluded that practitioners are in a hard place when it comes to treating sciatica. There’s no hard evidence showing an effective and long-term treatment, leaving a doctor with only empirical evidence, relying on his own experience or trial and error in treating this type of back pain.
The first study reviewed was published in the Annals of Internal Medicine in 2012. It looked at epidural injections for sciatica and found that they only provided modest short-term pain relief in some adults.2 The second study was published in the British Medical Journal and was an article review of 23 articles dealing with analgesics (pain medications) for sciatica.3 None of the 23 studies showed any significant benefits to using pain medications for sciatica. Both of these studies showed modest, temporary sciatica relief at best. In fact in a December 2014 study, doctors say that pain medications and surgery are not the answer and researchers need to look into gene therapy and stem cell therapy for back pain.4
The term sciatica is thrown around loosely and is often used for any pain traveling down the leg. True sciatica is a nerve injury that causes extreme pain. In true sciatica, the sciatic nerve is being pinched due to a herniated disc, spondylolisthesis, or foraminal stenosis. However, many patients are diagnosed with “sciatica” when, in fact, their sciatic nerve is not getting pinched.
Typically people between the ages of 20 and 40 may present themselves at the doctor with a prolapsed or herniated disc in the spinal column that presses on a spinal nerve root. A prolapsed disc may often occur as a result of straining to lift a heavy object. In older people, sciatica may be caused by body changes in the spine as a result of various conditions, such as bone spurs and osteoarthritis. Pregnant women may develop sciatica during the last few months of pregnancy due to postural changes that cause increased pressure on the sciatic nerve. The nerve can also be damaged by diseases such as diabetes. Other risk factors include obesity, which increases the stress on the spine and can contribute to the spinal degeneration that can cause sciatica. Also, individuals with occupations that require heavy lifting or prolonged periods of sitting are more likely to develop this condition.
Muscle spasms and sitting in an awkward position for long periods of time are relatively common causes of brief episodes of sciatica in all age groups. Pain occurs when the nerve is injured or compressed, usually where it leaves the spinal cord. Often, only one leg is affected. In rare cases, sciatica is the result of a tumor on the spinal cord. Sciatica may also be due to ligament laxity in the sacroiliac joint, which can cause radiating pain down the side of the leg, as well as numbness, a symptom that has traditionally been attributed only to nerve injury.
Indications the symptoms are caused by a “pseudo sciatica” ligament injury rather than nerve injury:
- You can sit in a chair and raise your leg straight out in front of you without reproducing your pain.
- Your low back pain is greater than your leg pain. Leg pain is 25% or less of the pain.
- The pain isn’t to the point of causing you to sweat.
- No numbness in your leg or foot.
- You experience numbness, but can touch the area and have sensation of touch there. This is a referral sensation, generally from a ligament injury, not a nerve injury.
Initial treatment is generally the application of ice or heat. Over the counter pain relievers and non-steroidal anti-inflammatories are usually part of the first line of treatment. Activity is generally curtailed, and heavy lifting is to be avoided. Abdominal strengthening exercises may be encouraged to strengthen the spine and boost flexibility of the spine.
If these measures are unsuccessful, then steroid injections to reduce inflammation around the nerve are frequently recommended. However, both anti-inflammatory medications and steroid injections have been shown to produce long-term loss of function and even more chronic pain by actually inhibiting the healing process of soft tissues and accelerating cartilage degeneration. Steroid injections often provide quick relief, but may have serious consequences.
Other medications, such as narcotics, may be prescribed to help reduce the stabbing pains of sciatica. Physical therapy may also be recommended.
When these treatments are unsuccessful, the recommendation then is frequently lumbar spine surgery. A sciatica complaint may be diagnosed from an “abnormality” on an MRI scan. It is important to note that many people have herniated disks or bone spurs that will show up on MRI’s and other imaging tests but cause no symptoms. The sciatica complaint very possibly was a simple ligament problem in the sacroiliac joint. For the majority of people who experience pain radiating down the leg, even in cases where numbness is present, the cause of the problem is not a pinched nerve but sacroiliac ligament weakness.
The problem with this surgical approach is that it does nothing to repair the weakened ligament in the sacroiliac joint and, thus, does not alleviate the symptoms that people with sciatica experience.
Prolotherapy treatment for Sciatica
Rather than boosting degeneration in the low back with cortisone, or taking the drastic approach of surgery, we recommend regenerative ligament repair with Prolotherapy. Prolotherapy eliminates pain in the local ligament, in this case the sacroiliac ligament in the sacroiliac joint, as well as the referred pain, and is curative in most cases of sciatica. In fact, the referral pain patterns of the sciatic nerve and of the sacroiliac ligaments are similar. Both pain and numbness typically associated with sciatica can be successfully treated with Prolotherapy to the sacroiliac ligament, and can prevent thousands of dollars being spent on surgery and post-operative care.
Comprehensive Prolotherapy for sciatic pain involves treating all of the affected areas, such as the sacroiliac ligament attachments and the lumbosacral area as necessary. Prolotherapy injections stimulate the body’s own natural healing process which is through inflammation. The inflammation causes the blood supply to dramatically increase in the injured areas, alerting the body to send reparative cells to the ligament site. Ligaments, such as the sacroiliac ligament are made of collagen. In this healing process, the body deposits new collagen. The sacroiliac ligament will then be strengthened and tightened as this new collagen matures. The sacroiliac joint which was unstable, will then become strong and stabilized, and the symptoms will abate.
1. Leavitt, SB. (April 27, 2012). Treatments for Sciatica Pain Disappointing. <em>Pain Treatment Topics</em>. Retrieved from: <a href=”http://updates.pain-topics.org/”>http://updates.pain-topics.org/</a>.
2. Cohen SP, White RL, Kurihara C, et al. Epidural Steroids, Etanercept, or Saline in Subacute Sciatica: A Multicenter, Randomized Trial. Ann Int Med. 2012(Apr);156(8):551-559.
3. Pinto RZ, Maher CG, Ferreira ML, et al. Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis. BMJ. 2012(Feb);344:e497
4. Hsu E, Murphy S, Chang D, Cohen SP. Expert opinion on emerging drugs: chronic low back pain. Expert Opin Emerg Drugs. 2014 Dec 18:1-25. [Epub ahead of print]