The sciatic nerve pain, also called sciatica, sciatica or simply sciatica, a pain of neuropathic origin, which occurs when the sciatic nerve is inflamed. The classic clinical picture of sciatica is lumbar pain radiating to one leg and may also be loss of sensation and muscle weakness in the affected limb.
The sciatic nerve, also called sciatic nerve arises from the junction of the nerve roots that arise between the 4th and 3rd lumbar vertebra of the sacrum, yielding a thick nerve descends toward the lower member.
The sciatic nerve is the longest nerve in our body, ranging from the lower back to the feet, through the buttocks, thighs and legs. Along its path, several branches are launched in order to innervate the structure of the lower limbs such as muscles, joints and skin.
The root compression of a spinal nerve is called radiculopathy. Sciatica is usually due to compression of one of its roots in the lumbar or sacral spine and is considered therefore a lumbar radiculopathy.
When a nerve is compressed, it becomes swollen and inflamed, causing pain along its path and, in some cases, loss of muscle strength and numbness in the affected area.
The main cause of the sciatic nerve compression and hence of sciatica is disc herniation in the lumbar spine. Other Sciatic Nerve compression causes are spondylolisthesis (slippage of one vertebra over another), trauma, tumors or infections of the lumbar spine stenosis (narrowing) of the spinal canal which passes marrow, osteophytes (parrot beak) or arthrosis column.
Another possible cause of sciatic nerve pain is a condition called piriformis muscle syndrome. This problem arises when the piriformis muscle, located in the gluteal region, suffers a spasm and causes sciatic nerve compression which passes underneath it.
The main risk factors for the development of sciatica are:
Old age: Elderly patients are at greater risk of degenerative problems of the spine, being much more common occurrence of disc herniation, parrot's beak or column arthrosis.
Obesity: overweight, especially after long years, overloads the lumbar spine, causing the occurrence of injuries or anatomical changes in it.
Heavy work: the type of occupation is also a relevant risk factor for sciatic nerve compression. People who work carrying weight, which often need to push with the back or spend long hours sitting or standing in one position also have a higher incidence of sciatica.
Sedentary lifestyle: Physical inactivity and lack of exercise for the muscles of the lower back also favor the emergence of problems in the column.
Diabetes mellitus: Diabetes is a disease that in itself causes damage to the peripheral nerves, and may the sciatic nerve and its branches are one of the affected.
Pregnancy: rapid weight gain, bodily changes and hormonal action, which causes relaxation of tendons and ligaments, can cause anatomical changes in the lumbar spine, favoring the sciatic nerve compression.
When a nerve is compressed, it becomes swollen and inflamed, causing pain along its path and, in some cases, loss of muscle strength and tactile sensitivity.
In the specific case of sciatic nerve compression, the most common symptom is back pain that radiates to the buttocks unilaterally, down the back of the thigh and side of the leg and foot. It notes that there is a sciatic nerve in each leg, but the sciatica typically affects only one of them, causing the pain arises only in one leg.
The intensity of the pain varies from case to case. It can be mild, causing only occasional discomfort or burning. In more severe cases, however, the pain can be excruciating, preventing the patient from standing. A sense of shock the nerve pathway is also common.
The sciatic pain may worsen after exercise, coughing or sneezing. Sitting still for long hours often also aggravate the symptoms of sciatica.
In addition to pain, sciatic nerve compression can also cause numbness, tingling or reduced muscle strength in the affected limb. In severe cases, the patient may experience urinary or fecal incontinence.
In many cases, sciatica is typical and are not required complex tests for diagnosis. The additional tests are usually ordered when the pain is very intense and / or when there is no improvement after initial treatment.
Electromyography and nerve conduction studies may be useful when there is doubt about the diagnosis. Already imaging tests such as MRI or CT scans are commonly used to identify the cause of sciatica, especially if this is caused by injuries such as herniated disc, nips the marrow canal or tumors.
The initial treatment of sciatica is with drugs for pain control, such as anti-inflammatory or pain-relievers. In many cases, the pain lasts a few days and disappears without any more aggressive behavior.
In cases of severe pain, opioids (morphine derivatives) may be required. The use of muscle relaxants or benzodiazepines such as diazepam, also help in controlling the symptoms. As the pain of sciatica is pain of neurological origin, drugs with antidepressants or anticonvulsants can be used to control more chronic pain.
No need physical rest. In fact, light activities that do not overload the column, seem to improve more to sciatica than lie in bed. Swimming and physiotherapy usually have good response. In some cases, acupuncture also gives good results.
Depending on the cause or severity of sciatica, surgery to correct the injury in the lumbar spine is the only option for ultimate control of pain.
