Disease Description (Causes and Symptoms)
Disease name: Sciatica (Sciatica) — a medically commonly used term.
- Definition and pathophysiology: Neuralgia originating from the sciatic nerve, causing radiating pain and sensory disturbances extending from the buttocks along the thigh, calf, and foot due to compression or irritation of the lumbar nerve roots (mainly from herniated discs in the lower lumbar spine) or damage to the nerve itself. Other causes may include spinal stenosis, tumors, infections, trauma, and compression by muscles (e.g., the piriformis muscle).
- Main symptoms: Aching or burning pain radiating down one leg, tingling or numbness, muscle weakness, and difficulty walking. Symptoms tend to worsen with coughing, sneezing, sitting, or bending. In severe cases, bladder or bowel dysfunction (cauda equina syndrome) may occur.
Treatment Methods (Standard Treatment, Medication, Procedures/Surgery, Lifestyle Management and Precautions)
- Conservative (non-surgical) treatment (initial priority)
- Activity modification: Complete bed rest is not recommended; after a short period of rest when pain is severe, a gradual return to daily activities is recommended
- Medication: NSAIDs (such as ibuprofen), acetaminophen, muscle relaxants, short-term oral steroids (selectively), and medications for neuropathic pain (gabapentin, pregabalin, and some antidepressants)
- Physical therapy: Stretching, core-strengthening exercises, manual therapy, and structured rehabilitation exercises
- Procedural conservative treatment: Epidural steroid injections (epidural injections), nerve root blocks, etc. (used to relieve symptoms)
- Assistive devices: Short-term use of a corset or similar device may be possible
- Surgical treatment
- Indications: Cauda equina syndrome (bladder or bowel dysfunction, severe sensory or motor loss in both lower limbs), rapidly progressive neurological deficits, or persistent severe pain and neurological abnormalities after conservative treatment (usually persisting or worsening for 4–6 weeks or longer)
- Examples of procedures: Microdecompression (microdiscectomy), laminectomy (decompression), foraminotomy, and, if necessary, fusion (in cases of instability)
- Lifestyle management and rehabilitation
- Early exercise (within the range allowed by pain), weight management, smoking cessation (smoking is associated with delayed healing), and regular stretching and strengthening
- Precautions and risk of complications
- Prolonged neglect may lead to chronic pain and functional impairment
- Immediate emergency treatment is required if cauda equina syndrome occurs (surgery may be necessary)
- Permanent sensory or motor impairment may occur with long-term nerve damage
Checklist Before an Outpatient Visit (Including Example Questions)
Items and records to prepare
- A list of currently used medications (including prescriptions, over-the-counter medications, and supplements)
- Copies or CDs of previous imaging results (recent MRI/CT/X-ray)
- Results of recent tests (blood tests, neurological tests, etc.)
- Symptom records: onset, factors that worsen or improve symptoms, pain intensity (pain scale), distribution (from where to where), and accompanying symptoms (tingling, numbness, weakness, urinary problems)
- Previous treatment history: medication, physical therapy, injection treatment, surgery, etc.
- Occupation, exercise habits, and whether you handle heavy objects
Information to include when explaining your condition to the doctor during an outpatient visit (examples)
- When the pain started and its progression (sudden? gradual?)
- Changes in pain when sitting, standing, coughing, or sneezing
- Whether your leg gives way (experience of falling), and whether you have bladder or bowel problems
- The activities that are most uncomfortable in daily life (e.g., walking, putting on shoes)
General Example Questions to Ask the Doctor
- What are the main side effects and expected benefits of this medication?
- What is causing my pain, and what is the exact diagnosis?
- How long should I wait with non-surgical treatment before considering surgery?
- When can I start exercising or return to work?
- What lifestyle habits should I change to prevent the symptoms from recurring?
Examples of Disease-Specific Questions
- Based on my imaging (MRI) findings, could you explain specifically whether surgery is necessary?
- Based on my current pain and neurological examination results, how likely is a procedure such as an epidural steroid injection to help?