What is sciatic pain?

Sciatic pain is one of the most frequent reasons for consultation in Pain Units. It is a particularly complex type of pain, as it presents characteristics of neuropathic pain, which means that it can manifest itself with very particular sensations: numbness, electric shocks, numbness or even exaggerated sensitivity along the path of the affected nerve.

Sciatica can originate at different levels of the spine – cervical, dorsal, lumbar or sacral – since in each vertebra the spinal cord gives rise to nerves that provide sensitivity and mobility to the arms, trunk, abdomen, legs and pelvis.

How does sciatica manifest itself?

Characteristic symptoms of radicular pain

Depending on the level of the spine where the nerve compression occurs, symptoms may vary. Among the most frequent are:

• Numbness.

• Electrical discharges.

• Numbness.

• Pain radiating to the arms or legs.

• Allodynia: intense sensitivity to touch, similar to the sensation of burning skin.

In more advanced situations, sciatica may be accompanied by motor deficit, i.e. loss of strength or inability to move a limb. This sign requires urgent assessment, especially when foot drop or loss of mobility in an arm appears.

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 pathway. This compression may occur at its exit from the medulla or in more peripheral areas.

Among the main causes are:

Intervertebral disc problems

• Bulging.

• Disc protrusions.

• Herniated discs contained or extruded.

Arthrosis of the facet joints

The joints that stabilize the spine may hypertrophy, narrowing the space through which the nerve passes.

Stenosis

A very common term in resonance imaging. It can be presented as:

• Foraminal stenosis: narrowing of the foramen, the nerve exit canal.

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

Other situations

• Perineural fibrosis: scar around the nerve, typical in operated patients.

• Degeneration of adjacent levels: deterioration above or below a previous surgery.

Each of these causes generates similar symptoms, but requires specific treatment.

When is it important to see a doctor urgently?

There are signs that should be assessed immediately:

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

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

• Very intense and progressive pain that does not improve with medication.

In these cases, urgent surgery may be necessary within 24-48 hours.

How is sciatica correctly diagnosed?

Proper diagnosis requires:

• Detailed medical history (anamnesis).

• Physical examination.

• Imaging tests: MRI, CT or dynamic radiographs.

• Functional tests: electromyography and evoked potentials to assess the degree of nerve involvement.

Thanks to this information, the specialist can determine the exact cause of the radicular pain.

Treatment options

Treatments are adapted to the cause, the evolution of the condition and the severity of the symptoms.

Pharmacological treatment

Includes:

• Anti-inflammatory drugs.

• Analgesics and opiates.

• Antidepressants and anticonvulsants, especially useful for neuropathic pain.

Rehabilitation and physiotherapy

Essential for:

• Correct postural habits.

• Improve mobility.

• Strengthen the lumbar and abdominal muscles.

• Reduce the probability of relapse.

Interventional treatments

When conventional treatment is not sufficient, techniques that act directly on the cause are applied:

Epidural or foraminal infiltrations

Placement of:

• Corticosteroids (the most supported option).

• Anti-inflammatory drugs.

• Platelet-rich plasma.

• Medical ozone.

Under radiological or ultrasound guidance for maximum precision.

Radiofrequency of the dorsal root ganglion

Neuromodulatory technique effective in sciatica of more than 6 months, capable of reducing the sensitivity of the nerve by means of controlled currents.

Intradiscal therapies

Minimally invasive procedures to treat protrusions or herniations contained directly within the disc.

These therapies make it possible to avoid many surgeries when applied in appropriate cases.

What if I have already had spinal surgery?

Sciatica in operated patients needs specialized evaluation. Causes may include:

• Perineural fibrosis.

• Degeneration of adjacent levels.

• New compressions at higher or lower levels.

Clinical analysis, physical examination and imaging tests make it possible to establish the exact origin and define the best treatment.

Results and expectations

Interventional techniques are minimally invasive, are performed on an outpatient basis and allow the patient to return to normal activities the following day. In most cases, they produce a significant and lasting improvement in pain, often avoiding surgery.

The results improve when accompanied by:

• Physiotherapy.

• Weight loss.

• Postural reeducation.

• Strengthening of the spinal muscles.

A common pathology with multiple solutions

Sciatica can have different causes and manifestations. Thanks to advances in diagnosis and treatment, it is now possible to offer personalized, effective and safe options.

At MIVI Salud, the comprehensive approach and the combination of therapies allow us to address this pathology with precision, always seeking the best pain relief and the best quality of life for each patient.