Sciatic nerve pain? Learn the most effective techniques to relieve it
Sciatica or radicular pain is one of the main causes of radiating low back pain and one of the most frequent reasons for consultation in pain medicine units. It is estimated that between 1% and 5% of the world’s population suffers from sciatica at some time in their lives, with greater prevalence in people between 40 and 60 years of age. In industrialized countries, low back pain with sciatic involvement represents up to 20% of cases of work incapacity.
Sciatic pain is characterized by a burning, tingling or shooting pain that follows the path of the sciatic nerve from the lumbar region down the leg. Although in many cases the pain improves with conservative treatments, some people require more specialized approaches to prevent the progression of the condition and improve their quality of life without resorting to surgery.
2. Pathology Causing Sciatic Pain
Sciatic pain can be divided into radicular pain and pseudo-sciatic or pyramidal syndrome, depending on its origin:
Radicular pain due to spinal nerve compression.
This type of pain is caused by compression or inflammation of a nerve root in the lumbar spine. The main causes include:
- Herniated disc: This is the most frequent cause and occurs when the nucleus of the intervertebral disc displaces and presses on the nerve root.
- Lumbar canal stenosis: It is caused by the narrowing of the spinal canal, affecting the nerve roots, common in older people.
- Spondylolisthesis: The displacement of one vertebra over another can compress nerve structures.
- Osteophytes or vertebral osteoarthritis: Abnormal bony growths that reduce the space for the spinal nerves.
Pseudo-sciatica due to Pyramidal Syndrome
Piriformis or piriformis muscle syndrome is a cause of pain similar to sciatica, but is not related to nerve compression in the spine. In this case, the piriformis muscle, located in the gluteal region, contracts and compresses the sciatic nerve, generating symptoms similar to those of radicular pain.
3. Diagnostic Protocol from the Point of View of Pain Medicine
Accurate diagnosis of sciatic pain is essential in order to choose the appropriate treatment. From pain medicine, the following steps are followed:
- Clinical history and physical examination: Pain characteristics, triggering factors and the presence of neurological signs are evaluated. Tests such as the Lasegue test help to differentiate sciatica from other conditions.
- Pain and functionality scales: Tools such as the Visual Analog Scale (VAS) and the Oswestry Disability Index are used to assess the severity of pain and its impact on daily life.
- Imaging studies: Magnetic resonance imaging and computed tomography allow identification of radicular compressions, herniated discs or canal stenosis.
- Diagnostic blocks: Infiltrations with local anesthetics in the nerve root or pyramidal muscle can help differentiate the origin of the pain and guide treatment.