Anyone know about sciatic pain?

[johnpalmer]

So... it's been a month. Christmas eve, I went for a couple of relatively long walks, and later, my "hip" started hurting. Well, it's my sciatic. When I get up, or when my leg is in just the right position, it might cramp and make me unwilling to put weight on it (and if I do, it tends to cramp worse). It's become a constant factor in my life.

I chide myself for using dramatic language, but I've been in agony. Not all the time, but I realized any time one is in pain, and ready to hit things and cuss the air blue, and not really able to focus (except, possibly, in an emergency) on anything but the pain, it's accurate to say "in agony".

Sometimes I'm going without pain for hours - except there's always this background ache. And the fear has become a bit of a constant background. I don't know if getting up is going to be agony or not. I really want to get in my car and drive to a new See's candy that's open to get some dark-chocolate covered ginger, and an assortment of other candies, but part of me just doesn't want to, because I know getting out might be agonizing.

And I'm getting a bit scared.

Does anyone know what will help? I'm doing physical therapy, but I skipped this week because, honestly, I hurt so much, so often, that I just don't want to exercise. And while it's nicely relaxing to lay down and let them put their TENS unit and cold on, it doesn't help. (The TENS is distracting when it's buzzing but it doesn't help. Then again, for some reason, they put it in the small of my back. Maybe next time, if they put it where the pain is, it'll help. I dunno.)

Physical therapy might help, and it might be part of a long term solution, but mostly I want to know what will stop the pain, or put it in the background a bit.

Will NSAIDs help, or are they worthless when the sciatic is kicking up a storm?

Are there any muscle relaxants that won't make my brain swim through molasses? Or, will staying on muscle relaxants for a period of time *cure* the damn thing, so I should just take sick time and let my brain rot for a week?

Will narcotic pain killers help? I've started taking my Vicodin prescription, but I'm taking it because I know you can't take one pill, have it not help, and decide it doesn't help... but it's not helping yet. I don't like opiates (because their side effects are exceptionally bad for me), but *if* they help, I need help. The pain has gotten that bad. But, I know that some kinds of pain just aren't helped by opiates.

Is there something else that might help? Any other medication that might help, internal external, whatever? I'm okay with alternative therapies as well (except homeopathy - I can distill my own water, thanks), but I'd rather work with therapies I've heard work.

And... does anyone know if I'm getting to the point that I have to start accepting that maybe I'll have to live with this? It's been 5 weeks so far. Maybe that's perfectly normal, and lots of people have pain for five weeks, and then, a year later, are 100% pain free and healthy and active again. Does anyone know a bit about prognoses?

Comments

[bkwrrm-tx.livejournal.com]

I don't know much of anything about sciatic pain, but I'm sending you as much good energy for healing as I can.

*hugs*

[suzilem.livejournal.com]

1. Massage Therapist
2. Pain Management Therapist (if you're not seeing one yet)
3. Chiropractor

I hope you can get this resolved. Chronic pain sucks.

gingerly hugs offered.

[ftemery.livejournal.com]

My mom had very good results with a chiropractor/osteopath. Might take a few visits but if you get a good doc, should help.

That said, either heat or ice is something I would try.

Good luck and my sympathy.

[submarine-bells.livejournal.com]

I have a bit of experience with this sort of thing. First up, if it really is nerve pain such as sciatic nerve twanging, painkillers and anti-inflammatories are unlikely to do a lot for it directly. If there's inflammation associated with it (e.g. the sciatic nerve is twanging specfically because something else near it it is damaged/inflamed and that something else is twanging on the sciatic nerve) then it might help, a bit. Can't hurt to try, but don't hold your breath on it fixing it.

For me, I find that treatment by an osteopath really helps. If you've not met them, an osteopath is kind of like a gentler version of a chiropractor - they do similar manipulative stuff, but add a LOT more massage first to loosen things up before starting with the bonecrunching. That'd be what I suggest you try first.

I've heard (from the doctors I saw at a chronic pain management clinic some years ago) that for pain that's specifically nerve pain there are some anti-depressants that for some mysterious reason help where normal painkillers won't. If you have no joy with an osteopath, try asking a doctor (ideally, one who tries to keep up with current research, to some degree) about the anti-depressant for nerve pain thing. I don't know a lot about it, but it might be worth investigating if the osteopath option doesn't work for you.

[karenkay.livejournal.com]

Can you choose your physical therapist? Because you might want to try another one. I would definitely recommend a manual physical therapist: http://www.aaompt.org/. I went to a place in Austin when I dislocated my shoulder, and it definitely made a difference in my healing.

It dovetailed nicely with my Pilates training--I felt very much like I was getting the same story from both, and that the PT had a deep understanding of movement. (That's actually pretty rare for a PT in my experience. A lot of PTs seem to think muscles are static, and they think programatically about your treatment. I found the manual therapists to be much more personalized.)

I recently had back pain for several weeks, maybe a month, and I resolved it by adjusting the way I sleep--but this wasn't sciatic pain. However, I do recognize exactly how you experience your pain, and I sympathize--constant pain, even in the background, is wearing. You might want to think more about the ergonomics of your sleeping situation. (I'm assuming you've already looked at your work arrangement.)

Acupuncture or a chiropractor might help in the short term.

[essaying.livejournal.com]

My hip pain is (mostly) trochanteric bursitis, not sciatica. But the thing that helps it the most is icing it -- every night when it's bad, off and on for most of the evening. NSAIDS help too, but I can't take them very often (they do bad things to the rest of my body). And gentle stretching helps -- not the bursitis itself, but the muscle spasms that tend to build up around it when I resist the pain. Using a cane is not out of the question either.

FWIW, YMMV, et al.

[essaying.livejournal.com]

My spouse E's pain is primary nerve pain, and Lyrica changed his life -- turned him from Basically Disabled to Basically Not Disabled. He recently added another one of those seizure-meds-turned-nerve-pain-meds (can't remember the name), and it helped even more.

[essaying.livejournal.com]

Oh, and: Sciatica is sometimes actually spinal stuff, a herniated disc or something of that nature. My mom was crippled by sciatica in her 40s; she had a laminectomy and never had another day's trouble.

[kightp.livejournal.com]

As you know, I've been living with sciatica for ... hm ... something over 20 years now. Most of the time it's just minor background noise, but when it flares, it's disabling.

Of all the things I've tried, from drugs to exercise to various hands-on stuff, the only thing that reliably works to end a flare is a visit (or two, or three) to my chiropractor, who uses deep tissue massage, gentle spinal manipulation and a half hour on the TENS unit. (She's *not* a back-cracker, or one of those woo-woo chiros who wave weird devices over your back and talk bullshit at you). I'm not surprised that they're putting the unit on the small of your back; that's where the nerve bundle originates. The location where you *feel* the pain is not necessarily the site of the impingement. Nerves are weird like that.

I sometimes take ibuprofen, in moderate doses, while I'm working on the other stuff. That seems to take the edge off a bit, and settle any related inflammation. Narcotics don't do a thing for sciatic pain, IME,

Oh, and that pretzel-stretch. That helps a *lot*. I can actually feel it releasing the muscles that entrap my sciatic nerve.

Do you still have the Pete Escogue "Pain-Free" book? It might be worth digging it out and seeing what he recommends. ISTR the pretzel stretch was part of it, but there may have been other gentle exercises and stretches.

I so, so empathize about this. I know *exactly* how it feels, and it's very much Not Fun.

[caltastic]

Sciatica is caused by a herniated disc in your lower back, which is probably why that's what your physical therapist is concentrating on. Since it's agonizing pain, I'd recommend getting a referral to an orthopedic surgeon who can give you an MRI and whatnot to let you know if it's a disc problem and give you better ideas how to handle it.

[saoba.livejournal.com]

First off- chronic pain is exhausting, physically and mentally. That low-grade wariness of 'will this make it hurt?' takes up a sizable chunk of real estate in one's head.

Yeah. For me, with the Theoretical Shoulder, I've found that getting ahead of the pain can make a real difference. If I wait until it flares up badly the meds take longer and seem to help less. *insert frowny face here* I am not wild about needing meds to function but you plays the hand you get, you know?


I've had good but not entirely pleasant PT, pleasant PT that didn't seem to do a damn thing and PT that was neither helpful nor good. My experience is that PT can take a while to be useful but if it hits a point where it isn't helping- and your PT should be following up with you on that from appointment to appointment and adjusting what they do based in that feedback- but you may need to discuss changing PTs or modality of PT with your doctor.

I'd be about ready to push the doctor for some new avenue of treatment in your shoes.

[karenkay.livejournal.com]

Pete Escogue rules!

[johnpalmer.livejournal.com]

Alas, the stretch you taught me doesn't do anything. Or, if it does, the muscle might spasm again right away. But even while I'm stretching, it can hurt, and it doesn't get any better.

[kightp.livejournal.com]

Well, then, that suggests your problem probably isn't in the piriformis (the butt muscle that has a habit of clamping down on the sciatic nerve). So that's ... information. And also indicates that, in applying the tens unit to your lower back, your PT has probably diagnosed the source of the problem better than your Internet friends can.

[phoenixpdx.livejournal.com]

Must take exception to "sciatica is caused by a herniated disk". That's only one of the causes of sciatica. A more common is spasm in the piriformis muscle. And for someone like me, with a non-standard body, it's caused by extremely bad vectors and muscles going in directions they were never meant to go.

IME, narcotics do nothing for nerve pain, and not much for muscle pain. They make it possible for me to sleep, is about all.

For inflammation-type pain, I find a combination of ibuprofen & tylenol to be about as effective as vicodin, without the narcotic hangover.

For nerve-type pain (as in the post-polio stuff), I use gabapentin (Neurontin) and it works a LOT. Which I only notice when I've run out and stopped taking it for a bit.

I agree about a gentle chiro, and if at least some of the pain is stemming from an SI joint that is out, investigate an SI belt. When I wear mine, I find the sciatic issues reduce considerably. But mine is so weird anyway, no telling if it generalizes. :-)

[johnpalmer.livejournal.com]

Nod. I don't think there's any bone involvement, but we haven't really dug in yet. I did find that, surprisingly, some of my "nerve mobilization" exercises seem to help during the spasms. They hurt like hell, mind you - but the pain then transfers down the length of the sciatic and the muscles stop spasming. I hope that continues to hold.

[johnpalmer.livejournal.com]

Well, I might end up trying that - but I only had three sessions with my PT. While the stuff he thinks might help alleviate the pain are worthless, the exercises I was doing were interesting - I found them surprisingly hard to do in good form, and I thought I felt something changing.

There was one kind of like sideways rowing where I kept having to check my right foot - it didn't want to stay pointed forward. (Technically, the PT instructor checked my foot - I didn't even notice I was moving it!)

Which, hey, good news, but so far, not enough, and by the way *ouch*. But yesterday, I managed to stop the spasms. I feel a bit more hopeful.

[johnpalmer.livejournal.com]

Nod... I was kind of afraid of that (that nerve-pain wouldn't be helped) but it's good to have it confirmed.

The good news is I did get a spasm to stop last night by working the nerve path. I haven't had spasms yet afterward. It hurt like heck, but it's hurting less now. So, there's hope.

[johnpalmer.livejournal.com]

Nod. I thought heat was helping, but now I'm not sure. I could try ice, I guess. And, I did manage to get the spasms to stop last night - there might be hope.

[johnpalmer.livejournal.com]

Thank you :-).

[johnpalmer.livejournal.com]

Massage sounds better now - the PT mentioned that it might be that the nerve is "sticking" rather than being squeezed, and showed me some exercises for "mobilizing" it. I tried them when I last had spasms, and it seemed to help (though it hurt!).

But before... sometimes, I have no pain, none - and other times, I have awful, cramping, constant "I could scream!" pain. And other times, a nasty ache. I couldn't see how massage would help. But if it gets the nerve "unstuck" without as much pain as the exercises, I'm all for that.

Thank you.

[johnpalmer.livejournal.com]

Thank you ... it's good to know that there's something out there :-).

[johnpalmer.livejournal.com]

It might be - but it might be different. My PT gave me an exercise that's supposed to mobilize (he jokingly called it "flossing") the nerve. It helped. (Hurt like hell, but once I stopped, it *just* hurt... the spasm stopped.)

[johnpalmer.livejournal.com]

The doctors don't think there's bone involvement - though they haven't done an MRI yet to verify. I don't think there's bone involvement, either... it seems to start right by the piriformis, and I don't think it gets any higher. But that's still a damn good point - there's lots I haven't even looked at yet, it's much too early to start worrying about "what if it never goes away". Thank you.

[johnpalmer.livejournal.com]

Well, I had one bit of good luck - I was able to do the "nerve mobilization" exercises my PT showed me during my last spasm. He warned me that these can make the symptoms worse, but at the time, I was kind of scoffing, yeah, right, like it could be *worse*!

It hurt... but the spasms stopped. And then it hurt for a while, right down the nerve bundle, but just an ache, not a continuing spasm.

I might try the chiro, but right now, I'm "just" in pain, and have been since last night (well, about 3:00 in the morning)... no spasms, no fear of getting up, so I'm feeling hopeful.

[johnpalmer.livejournal.com]

Heh. You know, this is one reason I'm glad I posted about this. Yeah. I could have said to someone else that pain is exhausting. But somehow, I'm different :-). Thank you for reminding me.

It's not the needing the meds that bugs me, though... I've been on stimulants for over a dozen years; I think of those as my anti-suffering (versus anti-pain) meds. It's the side effects, one of which from the TMI category is something is already a bit of a plague for me, from time to time. And the other is the fog - which the stimulants don't necessarily pierce. But I've finally realized that I can fight past a fog better than I can ignore pain.

[siliconivy.livejournal.com]

Oh that sucks. I've suffered from sciatica for years, I think it has to do with all the traveling I did (sitting on planes, long car rides, etc). And while I've had pain, never to the extent that you do. I mean, yeah it HURTS, sometimes very bad, and sometimes its that aching pain

For whatever reason, I've never told a doctor about it. I mean, I know what it is, and when it flares, I deal with it & it eventually subsides. So I've learned more from reading the comments than I knew before now. I think mine is the piriforms (?) others mentioned. And the pretzel twist has helped me, and stretching in general, plus digging my thumb (or something comparable) right into the center of the knot to get it to release. It hurts while I do it, but eventually I get some relief.

Here's hoping you get some relief soon.

[karenkay.livejournal.com]

Well, it sounds like the PT at least helped you hone in on some stuff. Three sessions is really not very many. I wish you could spend time with my Pilates trainer!

[karenkay.livejournal.com]

A tennis ball is really useful for getting at piriformis knots--just put it on the floor and lie on it. Sometimes a golf ball will work, but I find them painful.

[siliconivy.livejournal.com]

Oh that is a great recommendation, thanks!!

[kightp.livejournal.com]

Srsly. I keep a golf ball on my desk at work for this very purpose. It hurts so good ...