Types of Sciatica Pain

Acute Pain

Acute pain has a cause and an effect, it's a symptom of something else. When your arm accidentally touches a hot oven door (cause), you get immediate pain (effect). That pain usually lasts for a week or so until the burn has healed. In most cases, there are no more problems associated with it.

 Acute sciatic pain happens when there is swelling and inflammation around the spine that pushes on the sciatic nerve. The nerve becomes irritated, and that causes pain.

Acute pain is pain that has only been present for a short time. I like to think of acute as new. A doctor would say, "you have an acute or new onset of sciatic pain. 

When acute pain occurs, the goal is to determine what is causing the pain and treat it. As with a burn, you identify the problem, apply a treatment, and the pain goes away.

Pain relief during the acute phase of any injury focuses on decreasing the inflammation.  Ice, over the counter pain relievers, rest, gentle movement and stretching are all appropriate treatments.

The acute phase can last from three to six months. Pain that lasts longer than that is considered chronic. However, it is essential to note that you can have multiple acute flare-ups of sciatic pain. You would treat each new flare-up as acute.

Chronic Pain

Chronic Pain is pain that persists once the involved tissue has healed or the irritation has resolved. Pain is considered chronic after six months.

 It is not often clear what causes chronic pain. With prolonged pain, the brain can become conditioned to send pain signals after the pain-causing stimulus is gone. Chronic pain is more vague and difficult to pinpoint. 

Pain management physicians specialize in treating chronic pain patients. These physicians have in-depth knowledge of the physiological aspects of pain and coordinate treatment for patients with varying levels of pain. They use higher levels of pain medication, perform nerve blocks, spinal injections, and other interventional techniques to treat pain.

Back pain often becomes chronic because there are so many factors at play. Arthritis, muscle spasms, and muscle imbalances that cause mechanical issues all contribute to prolonged, chronic back pain.

The muscles in your back are stabilizers and act to protect your spine from damage, so if they sense injury, instability, or anything other than normal movement, they tighten up to splint your spine. It is called muscle guarding

Although muscle guarding is your body's way of helping to prevent further injury, it can be detrimental at times. Muscle spasm and tightness contribute to back pain in a big way. This guarding creates a pain cycle. Your muscles get tight, causing pain; this causes psychological trauma, causing you to tense up, creating more tightness, which in turn creates more pain. The loop continues.

Getting stuck in this cycle may require medical intervention. Muscle relaxers and stronger pain medications are often needed to break this cycle.

How Long can a Sciatica Flare-Up Last?

 Acute Sciatica 

A typical sciatica flare-up usually lasts 2-3 weeks; however, it may resolve quicker with proper management of your symptoms.

~ Ice - Lay on a gel ice pack for 15-20 minutes, three times a day for the first 24 to 48 hours.

~Neutral Spine Position (Hips and knees both at 90 degrees) - Lay on the floor with buttocks and thighs against the couch and your calves on the cushions. You can also use a Swiss ball or couch cushions on your bed to achieve this position.

~Rest - A few days of rest is good, but try to avoid prolonged bed-rest as this may increase symptoms.

~NSAIDS (Over the counter Non-Steroidal Anti-Inflammatory Drugs)

~Gentle Movement - Low-level walking, exercise, and stretching.

~Compression Back Brace - To provide compression and stability to your back.

After you have had a few flare-ups, you may start to notice signs that you are about to have one. If you begin the treatment mentioned above as soon as you feel the first signs, you may be able to minimize the severity of the flare-up and shorten the duration.

Ignoring your symptoms and trying to push through is NOT a good idea. If swelling and inflammation are left untreated, nerve damage can occur, causing numbness and even severe weakness in your leg. Prolonged irritation may also cause the pain to become chronic.

Chronic Sciatica

Symptoms of chronic sciatica are usually not as severe and acute sciatica. You may experience a vague or slight sense of pain in your back, buttocks, or leg. 

The treatment for chronic sciatica pain differs slightly. Ice is always a good option if inflammation is present; however, heat is also an option for chronic pain. Heat helps to relax tight muscles and soothes arthritis pain. Heat can also be a useful tool in breaking the pain cycle.

Movement, such as walking, exercises, and stretching, also helps with chronic sciatica pain. 

Signs That Your Acute Sciatica Flare-Up is Resolving

Your acute sciatica is resolving when the pain begins to "centralize." Meaning that the pain starts to travel back up your leg toward your back. So if your pain was down to your foot and you wake up in the morning, and it is only at your thigh, it is beginning to centralize.

The main goal of "centralization" is for the pain to travel up to your low back and eventually resolve. 

Why Is My Sciatica Not Going Away?

Keep in mind that sciatica is a symptom of something irritating the sciatic nerve. If the pain isn't going away, then the irritation to the nerve is still present. A visit to your doctor is the next step. 

The doctor may prescribe an MRI to get a first-hand look at your spine. It will serve as a guide for treatment options as well as a comparison for future MRI studies.

Video courtesy of Physical Therapists Bob & Brad

 

Treatment Options For Chronic Sciatica

~Prescription medications - Muscle relaxers, antidepressants, steroids, and pain medications are some of the medicines used to treat chronic sciatica pain.

~Physical therapy - A physical therapist can help with behavior modification, exercises, stretches, and pain-relieving modalities such as ultrasound, TENS, and traction.

~Spinal injections - Under a local anesthetic, medication is injected into the spine at the level of the swelling and inflammation.

~Alternative therapies - Biofeedback, acupuncture, yoga, or chiropractic care are alternative therapies used for pain control.

~Surgery - Only a small percentage of patients will require surgical intervention. Two commonly performed surgical procedures: 

     1. Microdiscectomy - is a minimally invasive surgical procedure to remove disc fragments that are pressing on the nerve.       

     2. Laminectomy - is an open surgery to remove a piece of bone from the vertebrae called the lamina. Removing the lamina opens up space in the spine and relieves pressure on the nerves. 

    A Final Word

    Sciatica is one of the most common types of pain. It is also the most misunderstood. About 40% of people will get it at some point during their lifetime, and it becomes more frequent with age.

    Sciatica pain varies from one person to another. One person may feel a deep ache in their back, buttocks, and leg, and another may feel numbness or tingling. 

    A flare-up can last several hours, several days, or continue for weeks. Indication that the flare-up is subsiding is "centralization," or the pain traveling back up your leg toward your back.

     A common cause of sciatica pain is a herniated disc; therefore, if the pain does not subside or gets worse, you should see your doctor.

    Sources

    https://www.medicalnewstoday.com/articles/7619

    https://www.painscience.com/articles/sciatica.php

    https://www.novaactiverehab.com/pain-cycle/

    https://ascendortho.com/2017/03/08/the-number-one-way-to-know-your-sciatica-is-getting-better/

    https://my.clevelandclinic.org/health/diseases/12792-sciatica/management-and-treatment

    Below is a Pinterest friendly photo…. so you can pin it to your "back pain-free" Board!!