SEARCHING FOR RELIEF FROM SCIATICA PAIN
I was recently diagnosed with sciatica. I didn't have much pain initially, but it has been extremely painful the past few days. Would physical therapy be a treatment option? I don't like to take medications for pain. Are there other treatments I should try? Could surgery help?
Sciatica can cause significant discomfort. The good news is that time and treatment often resolve this condition. In most cases, surgery is not necessary.
Sciatica typically refers to pain from irritation of one of the spinal nerves in your low back. Although the source of the irritation is in your back, you feel the pain along the affected nerve where it is located in your leg after it exits the spine, typically in the buttock and leg. Sciatica usually affects only one side of the body.
Sciatica pain is often a dull pain, but it also can be sharp, and, at times, you may feel the pain travel or shoot down your leg. Symptoms may include numbness, tingling or weakness along with the pain.
Sciatica develops due to a change in one of the cartilage pads in your spine, called discs. A small component of the disc pokes into the spinal canal, creating inflammation, or swelling. That leads to inflammation of the nerve and triggers the symptoms of sciatica. Pressure on the nerve from the disc may contribute to sciatica, as well. Other, less likely, causes of nerve irritation include bone spurs, cysts or other lesions in the spine that grow near a nerve.
Physical therapy can be an excellent treatment option for sciatica. It often involves learning stretches to improve your flexibility, techniques for pain control and exercises to strengthen and condition the muscles that support your back. This type of physical therapy helps reduce sciatica pain and lowers your risk for future injuries. In addition to physical therapy, staying active in whatever type of physical activity you can best tolerate can ease pain and other symptoms, too.
Though you mention that you prefer to avoid medications, newer drugs can work quite well for pain caused by sciatica. They are not potentially habit-forming like narcotic drugs, or opioids, can be. Drugs like gabapentin, duloxetine, nortriptyline and pregabalin can be useful for managing severe pain or pain that makes it hard to sleep.
Corticosteroids are another treatment option. These potent anti-inflammatory drugs are delivered via an injection that places the medication where it is needed. You have an imaging exam, such as a CT scan or an MRI, before a corticosteroid injection, so your health care provider can see where the medication should go. Imaging also is used to guide the injection as it's being delivered to ensure safety and accuracy.
In about 90 to 95 percent of sciatica cases, the problem is successfully resolved with time and conservative, nonsurgical treatments.
Although uncommon, surgery may be recommended as a first step in treatment if weakness associated with sciatica is moderate to severe, if weakness gets worse over time, if symptoms affect both legs or if you are experiencing incontinence due to sciatica. Very rarely, sciatica can lead to extensive numbness in the buttocks and pelvic floor. When that happens, prompt surgical intervention is often required.
When sciatica is the result of a disc problem, as it is in most cases, and surgery is required, it can be quite effective. The procedure involves removing the portion of the disc that's affecting the nerve. The surgery usually takes about 75 minutes and requires one day in the hospital.
Randy Shelerud, M.D., Spine Center, Mayo Clinic, Rochester, Minn.
DIET AND CELIAC DISEASE WITH NO SYMPTOMS
If someone has been diagnosed with celiac disease but has never had any symptoms, is a gluten-free diet still necessary?
Following a strict gluten-free diet is important for anyone who has celiac disease, even if the disorder does not trigger any symptoms. Eating gluten when you have celiac disease injures the small intestine. Over time, that injury raises the risk for developing complications related to celiac disease.
In people who have celiac disease, eating gluten, a protein found in wheat, barley and rye, sparks an immune response in the small intestine that leads to inflammation. Over time, that inflammation damages the tiny, hairlike projections, called villi, which line the small intestine. Villi absorb vitamins, minerals and other nutrients from the food you eat. Normally, villi resemble the deep pile of a plush carpet, on a microscopic scale. The damage resulting from celiac disease makes the inner surface of the small intestine appear more like a tile floor. When that happens, the small intestine has difficulty absorbing some crucial nutrients the body needs to stay healthy and grow.
The symptoms and presentation of celiac disease can vary. In some cases, it may not cause noticeable symptoms right away. When symptoms do occur, they can include bloating and weight loss. Bowel changes due to celiac disease may trigger a range of gastrointestinal symptoms.
Some people who have celiac disease don't have any gastrointestinal problems. Instead, tests may reveal iron-deficiency anemia or premature bone disease. Less common symptoms can include an itchy, burning rash, called dermatitis herpetiformis, as well as heartburn, headaches, fatigue and joint pain.
When celiac disease doesn't cause symptoms, following a gluten-free diet may seem unnecessary. But it is critical for everyone with celiac disease to cut out gluten to avoid potentially serious complications.
For example, when the small intestine cannot absorb enough calcium and vitamin D, it may lead to softening of the bone in children and a loss of bone density in adults. Over time, a range of other problems also may develop as a result of the body not getting the nutrients it needs, from skin rashes and difficulty absorbing lactose to infertility. People with celiac disease who don't maintain a gluten-free diet also have a greater risk of developing several forms of cancer, including intestinal lymphoma.
Once gluten is removed from the diet, inflammation in the small intestine generally begins to lessen. Complete healing and regrowth of the villi may take several months to several years, so maintaining a gluten-free diet is vital.
Amy Oxentenko, M.D., Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn.
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