What is sciatic pain?

Sciatic pain is one of the most frequent causes of consultation in Pain Units. It is a particularly complex pain, as it presents characteristics of neuropathic pain. In more everyday terms, this means that it can manifest itself with very peculiar sensations: numbness, electric shocks, numbness or even extreme sensitivity in the affected area.

Sciatica can originate at different levels of the spine – cervical, dorsal, lumbar or sacral – because at each level the spinal cord gives rise to nerves that carry sensation to the trunk, arms, abdomen, legs and pelvic region.

How does sciatica manifest itself?

Characteristic symptoms of radicular pain

Symptoms depend on the level of the spine affected.
In general, they may include:

• Numbness.

• Electrical discharges.

• Numbness.

• Pain radiating to the arms or legs.

• Allodynia: an exaggerated sensitivity to touch, as if the skin were “burned”, even without visible injury.

In more severe cases, pain may be accompanied by motor deficit, i.e. loss of strength or inability to move a limb. This situation is a reason for urgent surgery, especially if there is foot drop or loss of mobility in an arm.

When compression directly affects the spinal cord, other symptoms such as difficulty walking or lack of coordination may appear.

What are the causes of sciatica?

The most common cause is compression of the nerve at some point along its course, either at the exit from the medulla or in more peripheral areas.

The main causes include:

Intervertebral disc problems

• Bulging.

• Disc protrusions.

• Herniated discs contained or extruded.

Arthrosis of the facet joints

The vertebral facets may hypertrophy and narrow the space through which the nerve passes.

Stenosis

The term “stenosis” appears frequently on MRI scans. It can be:

• Foraminal stenosis: narrowing of the foramen, the canal through which the nerve exits.

• Canal stenosis: reduction of the central canal by thickened disc, facets or ligaments.

Other situations

• Fibrosis (scarring) around a nerve, frequent in patients who have already undergone surgery.

• Degeneration of levels adjacent to previous surgery.

Each of these causes can produce similar symptoms, but with different therapeutic needs.

When is it important to see a doctor urgently?

There are symptoms that require immediate assessment:

• Established motor deficit: inability to lift the foot or move an arm.

• Symptoms of spinal cord compression: difficulty walking or lack of coordination.

• Very intense and progressive pain with no response to medication.

In these situations, surgery may be necessary in less than 24-48 hours.

How is sciatica correctly diagnosed?

The first step is a complete medical evaluation, which includes:

• Detailed medical history (anamnesis).

• Physical examination.

• Imaging tests: MRI, CT or dynamic radiographs.

• Functional tests: electromyography and evoked potentials, very useful to determine the degree of nerve involvement.

With all this information it is possible to identify the exact cause of the radicular pain.

Treatment options

Treatments vary according to the cause, the time of evolution and the intensity of the symptoms.

Pharmacological treatment

Oral drugs are usually the first choice:

• Anti-inflammatory drugs.

• Analgesics and opiates.

• Antidepressants and anticonvulsants, especially useful in neuropathic pain.

Rehabilitation and physiotherapy

Fundamental to improve function, correct habits and strengthen the muscles that protect the spine.

Interventional treatments

When conventional treatment is not sufficient, the Pain Units apply techniques that act directly on the affected area:

Epidural or foraminal infiltrations

Accurate placement of:

• Corticosteroids (the option with the most evidence).

• Anti-inflammatory drugs.

• Platelet-rich plasma.

• Medical ozone.

They are performed under X-ray or ultrasound guidance to ensure maximum accuracy.

Radiofrequency of the dorsal root ganglion

Neuromodulatory technique especially effective in sciatica of more than 6 months of evolution. Small controlled currents are applied to reduce pain sensitivity.

Intradiscal therapies

Through minimally invasive techniques it is possible to access the disc to treat protrusions or herniations responsible for nerve compression.

These therapies can prevent surgery when applied correctly and at the right time.

What if I have already had spinal surgery?

Sciatica in operated patients requires a specialized assessment.
The causes may be:

• Perineural fibrosis (scar around the nerve).

• Degeneration of adjacent levels.

• New compressions above or below the intervened segment.

Examination, clinical interview and imaging tests help to identify the origin of the symptoms and to select the most appropriate treatment.

Results and expectations

Interventional techniques are low invasive, are performed on an outpatient basis and allow the patient to resume daily life the following day. In a high percentage of cases, a significant and lasting improvement in pain is achieved, often avoiding the need for surgery.

Their success increases when combined with:

• Physiotherapy.

• Weight control.

• Postural reeducation.

• Strengthening of the spinal muscles.

A common pathology with multiple solutions

Sciatica can have many causes and express itself in different ways.
Thanks to advances in diagnostic and therapeutic techniques, it is now possible to offer personalized, effective and safe treatments.

At MIVI Salud, the comprehensive approach and the combination of treatments allow us to address these conditions with high precision, always seeking the greatest relief and the best quality of life for each patient.