Spirit of Women magazine is a national publication presented to women by hospitals and their physicians. The magazine provides up-to-date, evidence-based healthcare information and promotes our hospitals as leaders in women's health excellence.
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1 9 w w w. s p i r i t o f w o m e n . c o m S P R I N G 2 016 S P I R I T O F W O M E N SHUTTERSTOCK "O h, my aching back!" If you've never groaned about your back before, there's a good chance you will, since back pain affects 80 percent of us at some point in our lives. Sciatica—when pain shoots down your leg from your lower back to your foot, often accompanied by tingling or numbness—is one of the most common types of back pain. "Sciatica is a symptom that's often caused by a disc bulge or herniation, which pinches a nerve in the back," says Dr. Rudy Malayil, St. Mary's Medical Center, Huntington, W.Va. Back bone spurs or stenosis, a narrowing of the spine, can also compress a nerve in your lower back and bring on sciatica. Generally, back pain doesn't warrant a trip to the doctor, especially if you know why it's happening. But sciatica does, particularly if you also have other symptoms such as loss of bladder or bowel control, fever, chills or night sweats. To get the inside story, your doctor may order an MRI (magnetic resonance imaging) before determining what kind of treatment is likely to provide relief. COPING WITHOUT SURGERY When sciatica is the diagnosis, many doctors recommend taking these conservative steps first, both to manage sciatica and to prevent future flare-ups. Lose weight. Being overweight causes wear and tear on your ankles, knees and hips that gets transferred to your spine because you're limping or favoring one side. Aim for a normal body mass index of 18.5 to 24.9. Quit smoking. Smoking is bad for your back. "It decreases the blood supply to your discs," which have a marginal blood supply to begin with, says Dr. Mandeep Othee, a board certified pain medicine specialist at Medical Center Health System in Odessa, Texas. "When the discs aren't as nourished, they get weaker, bulge out and compress nerves, causing sciatica." Don't just sit there. If you spend most of the day tied to a computer, "get up at least twice in the morning and in the afternoon," says Dr. Othee. Standing unloads the discs in your back and stretches your back muscles. Push yourself. During a bout of sciatica, you probably won't feel like doing much. But don't take it easy for more than a few days. Bed rest and otherwise checking out from your normal activities can prolong and worsen pain, sending you into a spiral of deconditioning. Instead, take an over-the-counter pain reliever such as acetaminophen or ibuprofen, or a prescription pain medication such as Lyrica (pregabalin), and see a physical therapist who can help you strengthen your core muscles to help protect your back. "The weaker those [core] muscles are, the more likely you are to have back problems," says Dr. Regina Bower, a neurosurgeon with North Colorado Medical Center in Greeley, Colo. Exercise on your own too. Try back-friendly low-impact activities like walking, swimming or walking in a swimming pool using the water as resistance, logging miles on the elliptical machine, or biking. These activities will boost blood flow to your back muscles, which can help keep them limber and strong. Get an epidural. If you still have sciatica despite physical therapy, pain relievers and exercise, steroid injections could provide the relief you need. "A steroid injection in the epidural space in your back can decrease pain so that you can exercise and strengthen the muscles around your spine, to limit pain," explains Dr. Malayil. These short-acting medications work locally to relieve nerve pressure, with virtually no side effects. One targeted injection can provide months of relief, and patients can get up to three injections per year. "If shots don't help, you can try more aggressive physical therapy, which involves traction to pull the spine apart," says Dr. Othee. SURGICAL SOLUTIONS If your sciatica is debilitating despite all non-surgical treatments, or it's the result of a serious problem that requires immediate surgery, here are three of the latest cutting-edge options to discuss with your physician: Microdiskectomy: Under the guidance of an operating microscope, this surgery removes a small amount of tissue from a disc that's causing pressure on a nerve. Laminectomy: This surgery removes the lamina, the back part of the vertebra that covers the spinal canal. It enlarges your spinal canal to relieve pressure on the spinal cord or nerves. Spinal cord stimulation: With this surgical technique, two thin wires with electrical leads are threaded into the epidural space in your spinal cord. A tiny, programmable generator is also inserted under the skin in your stomach area through a small incision. The generator emits electrical currents to the spinal column, which blocks the pain pathways. Keep in mind that "surgery isn't the panacea you [might] think it would be," Dr. Bower says. "It's not without risk, and one of those risks is that you won't have improvement, or as much [improvement] as you would like." •