Sciatica can be a painful and challenging condition, but understanding the sciatic nerve, its importance, and the causes of sciatic pain can help you take the first steps toward relief. Pain management doctors are experts in diagnosing and treating sciatica, offering a range of treatments from medications to injections. In this article, Christopher Woolley, M.D., D. ABA, discusses this condition and treatment options.

What is the Sciatic Nerve?

The sciatic nerve is one of the most important nerves in your body. It starts in your lower back as spinal nerve roots coming from the L4 to S3 level and runs all the way down to your feet. It’s the longest and largest nerve in your body and is responsible for connecting your spinal cord with your leg and foot muscles.

Why Is It Important?

The sciatic nerve plays a crucial role in your ability to walk, run, and even stand. Here is why:

Movement: It controls the muscles in the buttock, back of your leg, your knee and lower leg.

Sensation: It allows you to feel sensations in the back of your thigh, part of your lower leg, and the sole of your foot.

Reflexes: It helps with the reflexes in your lower body. If something goes wrong with your sciatic nerve, it can cause a lot of problems. That is why understanding this nerve is so important.

Causes of Sciatic Pain and Where the Pain Can Be Located

Sciatica is the name for pain caused by irritation or compression of the sciatic nerve. In fact, according to Harvard Health up to 40% of people will experience it in their lifetime, and the chances of experiencing this pain increases as people age. But what causes this pain, and where can you feel it?

4 Common Causes

Herniated Disc: This is the most common cause of sciatica. A herniated disc occurs when one of the discs in your spine is damaged and presses on the roots of the sciatic nerve.
Spinal Stenosis: This condition involves the narrowing of the spinal canal, which can put pressure on the roots of the sciatic nerve.
Piriformis Syndrome: The piriformis muscle, located in the buttock region, can sometimes press down on the sciatic nerve if the muscle spasms or tightens.
Injury: A direct injury to the lower back or buttocks can damage the sciatic nerve.

Where Can You Feel Sciatic Pain?

The pain can be felt in various parts of your body, depending on where the nerve is affected.
Here is a breakdown:

• Lower Back: Often, the pain starts in the lower back.
• Buttocks: The pain can radiate from the lower back to the buttocks.
• Legs: You might feel pain down one or both legs, sometimes extending to the foot.
• Feet: In severe cases, the pain can reach your feet and toes.

The pain can be sharp, burning, or even feel like an electric shock. It can also cause numbness, tingling, or muscle weakness in the affected leg or foot.

How a Pain Management Doctor Can Help You

Dealing with sciatic pain can be a daily challenge. The good news is that a pain management doctor can help with diagnosing and treating all types of pain, including sciatica. “As a pain management physician, we have lots of options for treating leg pain like sciatica,” says Christopher Woolley, MD, D. ABA. “There are procedures such as epidural steroid injections that can be done in our office that are performed at the level of the spine that may be causing the problem. If someone has tried epidural steroid injections but has not found relief (or has only gotten short term relief with these), we have other non-surgical interventions like spinal cord stimulation that can help with sciatica symptoms. Aside from interventional options, we have many different nerve pain medications or types of physical therapy we can recommend that are helpful with sciatic nerve pain. “

What Does a Pain Management Doctor Do?

• Diagnosis: The first step is to find out what is causing your pain. The doctor will ask about your symptoms, perform a physical exam, and might order imaging tests such as an MRI or X-ray.
• Treatment Plan: Once they know the cause of your pain, they will create a treatment plan tailored to your needs.

Treatments for Sciatic Pain

Here are some common treatments that a pain management doctor might recommend:

Medications:

• Pain Relievers: Over-the-counter or prescription pain relievers can help reduce pain.
• Anti-inflammatory Drugs: These can help reduce inflammation around the sciatic nerve.
• Muscle Relaxants: If muscle spasms are causing the pain, these can help.

Physical Therapy:

• Exercises: Specific exercises can strengthen the muscles around your spine and improve flexibility.
• Stretches: Stretching exercises can help relieve pressure on the sciatic nerve.

Injections:

• Steroid Injections: These can reduce inflammation and provide relief from pain.
• Nerve Blocks: These injections can block pain signals from the affected nerve.

Lifestyle Changes:

• Weight Management: Maintaining a healthy weight can reduce pressure on your spine.
• Posture: Improving your posture can help prevent sciatic pain.
• Exercise: Regular exercise can keep your back strong and flexible.

In most cases, sciatica can be treated without surgery. However, if the pain is severe and does not improve with other treatments, surgery might be an option. A pain management doctor can refer you to a surgeon if needed.

By working with a pain management doctor, you can find the right treatment plan and get back to enjoying your life without pain. If you are dealing with sciatic pain, do not hesitate to set up an office visit with us at 775-323-2080.

While the dangers of tobacco to lung health are well-known, its harmful effects on spine health are often overlooked. This blog post explores the link between smoking and back pain, how lighting up can worsen existing spine issues and even delay the healing process of surgery.

 Smoking and Back Pain: A Dangerous Duo

Research confirms a disturbing truth: smoking can significantly contribute to, and worsen, back pain. Studies have shown that smoking accelerates spondylosis, a condition characterized by the degeneration of spinal discs and facet joints. Additionally, nicotine and other harmful chemicals in tobacco smoke restrict blood flow to your spine, impairing the delivery of vital nutrients and oxygen to the affected area. This compromised circulation can lead to inflammation, tissue damage, and heightened sensitivity to pain, making everyday movements even worse for smokers battling back issues.

How Smoking Hinders Healing

“Beyond making your existing back pain even worse, smoking can be an obstacle to your recovery from spinal surgery,” says Jay Morgan, MD, FAANS, neurosurgeon at Sierra Neurosurgery Group. The process of tissue repair and fusion, crucial for healing fractured vertebrae or addressing spinal conditions such as pseudarthrosis (a disease that occurs when a broken bone fails to heal after a fracture), can be significantly reduced in smokers. Nicotine disrupts the body’s ability to form new blood vessels, vital for delivering nutrients to injured tissues and helping the healing process. Because of this, smokers may experience delayed wound healing, an increased risk of complications after surgery, and a greater likelihood of failed spinal fusion procedures. This highlights the importance of quitting smoking 4-6 weeks before undergoing spinal surgery, and remaining smoke free 4 weeks after surgery, to better the chances of a successful outcome and long-term relief.

Going Up in Smoke: The Threat to Bone Density

Besides its direct impact on spinal health, smoking can indirectly contribute to back pain by decreasing bone density. Osteoporosis, a condition causing  weak and brittle bones, is more common among smokers due to the harmful effects of tobacco on bone metabolism. Research suggests that smoking accelerates bone loss, heightening the risk of fractures in the spine and other bones. These fractures can trigger excruciating back pain, reduced mobility, and an increased risk of further injuries. By undermining bone strength, smoking not only aggravates existing back pain, but also sets the stage for future spinal complications.

Conclusion: The evidence is clear: smoking poses a significant threat to spine health, worsening back pain and slowing down the healing process for those struggling with spinal injuries or undergoing surgery. From accelerating spinal degeneration to weakening bone density, tobacco takes a negative toll on your spine. However, by embracing a smoke-free lifestyle, you can take proactive steps towards relieving your back pain, promoting healing, and ensuring the future health of your spine.

Spinal discs become worn out and weaker as we age.  About 40% of adults over age 40 have at least one degenerated vertebral disc. As adults reach the age of 80, this percentage doubles, which means most people will likely have to deal with disc disease at some point in their lives. 

If you or someone you know have been diagnosed with chronic pain due to degenerative disc disease, treatments are available to address your symptoms and improve your quality of life. Some of the most current and effective pain management solutions for disc degeneration are physical therapy, NSAIDs (such as Advil) and epidural steroid injections.  If pain management treatments do not provide adequate relief, surgery may be indicated based on your medical history, physical exam(s) and imaging studies such as an MRI.

Your Low Back is Complex

Your spine is an intricate system of working parts.  It is made up of vertebrae, which are bones that stack like building blocks and are separated by discs, which serve as cushions between the vertebrae.  The components of the vertebrae form a protective case around the spinal canal, which houses a fluid-filled sac containing spinal nerves. These nerves have the important job of carrying signals between the brain and body. Small openings in the vertebrae, called the foramen, are formed by the stacked vertebrae, which provide a way for the nerve to leave the spinal canal.  The lumbar spine contains the five bottom vertebrae in the back. These vertebrae are named L1-L5.

The Causes of Degenerative Disc Disease

The constant wear and tear of daily life can weaken vertebral discs over time, making it more prone to damage from sudden movement or injury.  If the disc’s soft center begins to bulge, or the outside of the disc tears and the soft center squeezes through, a nerve may become irritated or pinched.  This can cause pain, burning, tingling or numbness in the leg.  Pressure on a nerve that connects to the sciatic nerve may cause pain in the buttock and down the leg.

Also, as a disc wears out, the vertebrae above and below the disc begin to touch and abnormal bone, called bone spurs, grow.  The foramen or the spinal canal can then narrow, causing irritation of a nerve.

Vertebral discs are predominantly made up of water, and as we age the core of the discs gradually lose some water, reducing their ability to provide a cushion to absorb shock. The loss of water in your discs lead to disc space collapse, which can cause increased back pain and nerve pressure.

Diagnosis and Symptoms of Back Pain

One of the primary reasons degenerative disc disease often goes undiagnosed is that the pain is not constant and often comes in waves, causing pain in your neck and back that can last for months at a time and then subside for months at a time. One nearly-universal symptom associated with degenerative disc disease is numbness or tingling in your arms or legs that extends down to your buttock and lower back. Also, if your back and neck pain intensifies when you sit, bend or lift, it may indicate you have degenerative disc disease.

Selecting Your Pain Management Specialist and Spine Surgeon

The diagnosis and treatment for degenerative disc disease can be emotionally and physically challenging for you and your family. The selection of a pain management team, or even a surgical team, is an important part of your treatment plan. Many patients seek a specialist with exceptional clinical training and years of experience. Accessibility, location, insurance, and convenience and comfort for both you and your family are also key considerations. Do not hesitate to ask questions when selecting a pain management specialist. Here are a few questions to ask potential pain management specialists that may help guide your decision.

1. What is the clinician’s and team’s overall approach to treatment?
2. What experience and training does the clinician have in the diagnosis of degenerative disc disease?
3. How is the diagnosis made?
4. How is a treatment plan developed and who is involved?
5. Where can patients read genuine reviews about the clinician(s)?

Treatment Options for Degenerative Disc Disease

The first course of action for treating degenerative disc disease is implementing conservative measures.  Only if these prove unsuccessful is surgery then considered.

NSAIDs are either over-the-counter or prescription strength. Common examples include ibuprofen (such as Advil or Motrin), naproxen (such as Aleve), and aspirin. NSAIDs reduce the body’s production of chemicals called prostaglandins, which trigger inflammation and pain.  NSAIDs can have both positive and negative effects and should only be taken under the guidance of a physician.  If you are on blood thinners, have kidney disease or other medical conditions, consult with your physician before taking NSAIDs.

Physical therapy and movement changes involve a specific series of stretching and flexibility exercises, strengthening exercises, low-impact aerobic exercises and key movement changes. Physical therapy might sound intense if you are suffering from chronic pain, but good physical therapists know how create an exercise routine that is manageable. Key protective movements that can help protect your vertebrae include:

• Tightening the muscles in your stomach to support your spine.
• Keeping your ears, shoulders and hips in a line.
• Bending at the hips and knees, not your waist.
• Moving your body as a unit and avoid twisting at your shoulders or waist.

Epidural steroid injections are intended to calm the problematic nerve that is affected by the diseased disc. This minimally invasive and low-risk procedure does not correct the structural damage to your spine but can improve inflammation, will usually ease your chronic pain, and improve your quality of life.

Facet joint injections may be effective in relieving pain and inflammation.  This procedure involves injecting a soothing mixture of numbing anesthetic and anti-inflammatory steroid medication into the joints on the side of your spine.  This non-surgical option may provide pain relief for a span ranging from several days to several months.  Up to three injections may be given per year.

Lumbar medial branch blocks are another minimally invasive procedure, used to help identify if your pain is originating from the facet joints. If this is the case, long lasting relief can be provided with a radiofrequency ablation (RFA) of irritated nerves overlying these joints.  First, anesthetic medicine is injected around the nerves.  If the injection/block provides pain relief, results are considered “positive” and the radiofrequency ablation procedure may be considered.  RFA uses an electric current to heat up a small area of nerve tissue to stop it from sending pain signals to the brain.

Spinal Cord Stimulation, also called SCS, uses electrical impulses to relieve chronic pain.  It is the belief that electrical pulses prevent pain signals from being received by the brain. The treatment starts with a trial implantation to determine if a SCS is effective for you.  If the amount of pain relief is acceptable, a permanent implant is placed and the electric impulses are controlled with an external wireless programmer.

Surgery may be an option if conservative and interventional treatments fail and the pain continues for an extended period.  There are many factors taken into consideration when discussing surgical options, which are customized for each patient’s unique needs.

One surgery commonly used for degenerative disc disease is a laminectomy, in which some or all of the lamina is removed from the affected vertebrae.  The opening created may be enough to take pressure off the nerve.  If needed, the surgeon can also remove any bone spurs or disc material still pressing on the nerve.

Another surgical option is an anterior cervical discectomy fusion (ACDF).  In this procedure, the affected intervertebral disc and adjacent bone, if necessary, is removed to take pressure off the nerves and align the spine.  This surgery is performed less frequently than a laminectomy.

For the best outcomes, treatment is a partnership between the clinical experts, the care team supporting the physician(s), and you and your family.  Patient education videos on degenerative disc disease and information on Sierra Neurosurgery’s conservative and effective approach to treatment can be found at www.sierraneurosurgery.com/surgical-procedures.

An estimated 50 million Americans, or 20% of the entire population¹, are living with chronic pain. In fact, chronic or acute pain is the most common reason adults seek medical care. Unfortunately, acute and chronic pain can lead to a decreased quality of life, opioid dependence, and diminished mental health in the form of anxiety and depression. 

Most often, the pain is felt in soft tissue areas, such as the lower back, neck and shoulders, hips, legs and buttock area. If you or a loved one are experiencing chronic pain, Sierra Neurosurgery Group offers treatments to address your symptoms.  

There are many options for interventional chronic pain treatment. These include trigger point injections, epidural steroid injections, nerve blocks, radio-frequency ablations (RFA), facet joint injections, spinal cord stimulation, and intrathecal pump placement.

Symptoms of Chronic Pain

Chronic pain is defined as pain that has been present for at least 12 weeks. The pain varies and may feel dull or sharp and may cause a burning or an aching sensation in the back, neck, limbs or feet. It may occur on one side or both. Other symptoms of chronic pain include throbbing, stabbing pain, tingling, weakness, and numbness. The intensity and presence of severe chronic pain may also lead to psychological symptoms such as depression, anxiety and fear. 

Types of Chronic Pain

Chronic pain may be caused by a variety of different stressors including spinal injury or stenosis, headaches, post-surgical pain, post-trauma pain, lower back pain, cancer pain, arthritis pain, neurogenic pain (caused by damaged or compressed nerves in the spine or neck), and psychogenic pain⁵. Two very common types of chronic pain that are treated by trigger point injections are fibromyalgia and tension headaches.

Fibromyalgia is a disorder indicated by universal musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues. Researchers believe that fibromyalgia increases pain by compromising the manner in which your brain and spinal cord process painful and non-painful signals.²

Tension Headaches typically range from mild to moderate pain that’s often described as a tight band around the head. Tension headaches are the most common type of headache, but the research behind the cause of the headaches is murky at best. The two types of tension headaches are episodic tension-type headaches and chronic tension-type headaches. ³

Selecting Your Interventional Pain Management Specialist 

The diagnosis and treatment of chronic pain can be emotionally and physically challenging. The selection of a pain management team is an important part of your treatment. We recommend you seek a specialist with Board Certification in Anesthesiology, followed by additional fellowship training in Pain Management. Interventional Pain Management specialists focus on treatments vs. medications, which merely mask the pain. Location, insurance coverage, nurse support and your patient experience are also key considerations.  Do not hesitate to ask questions and address concerns when selecting an interventional pain management specialist.  Here are a few questions to ask:

1. What is the physician and nursing team’s overall approach to treatment?
2. What experience does the clinician have in the treatment of chronic pain?  How big a part of his/her practice is it?
3. Does the physician have any board certifications?  If so, in what?
4. How is the diagnosis made?
5. How is a treatment plan developed?  Who is involved?
6. Where are procedures like Trigger Point Injections or Facet Joint injections done?
7. Where can I read reviews from your verified patients?

Treatment Options for Chronic Pain

Treatment options differ based on the type and location of the chronic pain, duration of your symptoms, your age and overall health, and other therapies that may have been tried. Treatments may include trigger point injections, medications, lifestyle changes, and supportive physical therapy. 

Common medications to treat chronic pain are non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin, Aleve, etc.) and acetaminophen (Tylenol, etc.). For severe cases of arthritis, COX-2 inhibitors such as Celecoxib are commonly used. Antidepressants and anti-seizure medications have been found to help patients who also experience psychological symptoms.¹ The strongest pain medication is also potentially the most detrimental to your long term health: Opioids such as hydrocodone, oxycodone, or fentanyl.  Interventional pain management specialists will work with you to try to reduce or eliminate this category of medications. 

During a Trigger Point Injection, the board-certified anesthesiologist carefully inserts a thin needle through the skin into sensitive portions of the muscle. The insertion of the needle into a trigger point area causes the muscle to relax. Then an anesthetic mixture is injected which causes the trigger point to relax. If the trigger point does not relax completely after the first injection, the physician may adjust the needle’s position and give additional injections.⁴

For the best outcomes, treatment is a partnership between the clinical expert, the clinical care team, you and your support system, including family and friends. Patient education videos on Trigger Point Injections and many other pain management procedures can be viewed at sierraneurosurgery.com/pain-management-video-library.

Sources:

1. “Products – Data Briefs – Number 390 – November 2020.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 4 Nov. 2020, https://www.cdc.gov/nchs/products/databriefs/db390.htm.
2. “Fibromyalgia.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 26 Oct. 2021, https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780.
3. “Tension Headache.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 29 Sept. 2021, https://www.mayoclinic.org/diseases-conditions/tension-headache/symptoms-causes/syc-20353977.
4. “Trigger Point Injection (TPI) for Muscle Pain Relief.” WebMD, WebMD, https://www.webmd.com/pain-management/guide/trigger-point-injection.
5. “Chronic Pain: What Is It, Causes, Symptoms & Treatment.” Cleveland Clinic,          https://my.clevelandclinic.org/health/diseases/4798-chronic-pain.