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April 24, 2023

Sciatic nerve pain can be debilitating, but surgery often is unnecessary

Research suggests more conservative pain relief approaches are just as effective in the long-term

Adult Health Pain Relief
Sciatica surgery Sasun Bughdaryan/Unsplash

Pressure on the sciatic nerve can cause a wide range of symptoms, from a mild tingling or a dull ache to a more intense burning or sharp pain. In more severe cases, the pain can be very debilitating, affecting a person's daily life.

About 40% of Americans have experienced sciatica – pain that radiates from the sciatic nerve, which starts in the lower back and extends through the hips, buttocks and legs. Though the pain can be debilitating, surgery isn't the best option for everyone.

A new study suggests that long-term outcomes are about the same for both surgical and more conservative treatments for sciatic pain. Here's what people should know about treatment options for sciatica:

What is sciatica?

Sciatica is symptom of a medical condition that has caused injury to the sciatic nerve or placed pressure on it, according to Penn Medicine. The most common causes are a slipped or herniated disc, spinal stenosis, piriformis syndrome, spondylolisthesis or a tumor.

Sometimes women during pregnancy will experience sciatic pain. Diabetes also can cause nerve pain.

Pressure on the sciatic nerve can cause a wide range of symptoms, from mild tingling or a dull ache to a more intense burning or sharp pain. In more severe cases, the pain can be very debilitating, affecting a person's daily life. Some people may experience weakness in their affected legs or feet.

Certain movements may exacerbate the pain, like standing or sitting for long periods of time, bending backwards or walking long distances. Some people may experience pain when sneezing, coughing or laughing, or when they hold their breath.

When should you see a doctor?

Because the damage to the sciatic nerve can be caused by different medical conditions, experts stress the importance of identifying the source of the pain. A primary care doctor can perform an evaluation and conduct tests to identify the underlying problem. Once it is identified, a treatment plan can be developed, but there are some cases in which there is no detectable cause.

Non-surgical treatments typically are tried first to ease the pain and tamp down inflammation. These may include taking over-the-counter pain relievers such as ibuprofen or acetaminophen and applying heat or ice to painful areas. Health care providers also may recommend physical therapy as well as injections and oral medications that reduce the swelling around the nerve. 

Though people may need to reduce their activities for the first few days after the pain starts, experts say it is beneficial to keep moving as much as possible. Bedrest is not recommended.

Surgery to relieve the compression on the sciatic nerve usually is only recommended if more conservative treatments don't work or a person's medical condition worsens. Sciatica caused by a slipped disc or spinal stenosis can lead to permanent numbness or weakness in the leg.

When is surgery necessary?

Most people with sciatica can find pain relief with nonsurgical treatments; however, they can take time to work. Studies have shown that spine surgery provides superior immediate pain relief, but the patient's long-term outcomes are about the same whether they had surgery or stuck with more conservative treatments.

In the most recent study, patients who underwent surgery to partially remove ruptured discs – a common cause of sciatica – reported that the pain returned within a year. Researchers told U.S. News & World Report that many patients choose to undergo surgery, despite risks of infection, blood clots and disc tears, because there is little scientific evidence on nonsurgical treatment options. 

The study – an analysis of 24 previous studies – compared the potential benefits of surgery to non-surgical treatments like steroid injections and sham surgeries. Each of the participants had herniated discs; their pain relief was tracked for up to a year after treatment.

Though the surgery patients experienced promising pain relief in the first three months after their operations, by a year post-op the differences in pain relief between the two groups had disappeared.

Yet, when patients have long-lasting, persistent pain from a specific cause, surgical treatment can be beneficial. In one clinical trial, patients with persistent pain caused by herniated lumbar discs found superior pain relief through microdiscectomies than nonsurgical care.

Before considering surgical treatment for sciatica, John Hopkins Medicine experts say people should ask themselves these five questions:

• Do you know the cause of your sciatica?
• How is the pain affecting your quality of life?
• What treatments have you tried?
• What are your goals for the surgery? For example, do you want to be able to get back to your fitness routine quickly
• Do the benefits outweigh the risks for your particular situation?

People are advised to seek immediate medical attention if they experience unexplained fevers with back pain, back pain after a fall or injury, pain that travels below the knee, blood in the urine, lost control over bowel movements, or weakness or numbness in the buttocks, thigh leg or pelvis. Medical attention also should be sought if pain is worse at night or when lying down. 

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