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Sciatica

Intro

Call your doctor if any of the following conditions occur:

  • The pain is not improving after several days or seems to be getting worse.
  • You are younger than 20 or older than 55 years and are having sciatica for the first time.
  • You presently have cancer   or have a history of cancer.
  • You have lost a large amount of weight recently or have unexplained chills and  fever  with back pain  .
  • You are HIV   positive, or you use IV drugs.
  • You continue to have trouble bending forward after more than a week or two.
  • You notice weakness is getting more pronounced over time.

You should go to a hospital's emergency department if any of the following occur along with sciatica.

  • The pain is unbearable, despite trying first aid methods as described in the home care section.
  • The pain follows a violent injury, such as a fall from a ladder or an automobile crash.
  • The pain is in the back of your chest  .
  • You are unable to move or feel your legs or feet.
  • You lose control of your bowels or bladder or have numbness in your genitals  .
  • You have a high temperature (over 101°F).

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Self-Care at Home

Pain from sciatica will probably limit your activities. Here are some ways to ease the pain at home.

  • Do not bend, lift, or sit in a soft, low chair—your pain will get worse.
  • Unless you are allergic or should not take them for other reasons (if you take a blood thinner such as Coumadin, for example), over-the-counter pain medicines such as acetaminophen (Tylenol), aspirin (Bufferin or Excedrin), or ibuprofen (Advil, Motrin IB) will probably help ease the pain.
  • Try a cold pack to see if it helps the pain. If you don't have a cold pack, use a large bag of frozen vegetables; it makes a good first aid cold pack. Or have someone close to you massage you in a triangular pattern with an ice cube over the sore areas. The person should move the ice cube if your skin gets too cold (this may melt several ice cubes).
    • After the cold massages, try alternating with heat from an electric heating pad to see if it helps the pain. (Do not sleep with a heating pad on your back. It could cause a bad burn.)
    • If you don't have an electric heating pad, put a hand towel under hot water, wring it out, and place it on your back. Some physical therapy experts believe that moist heat penetrates more deeply and gives better relief of pain. (Do not use wet packs with your electric heating pad because electrical shock may result.)
  • You may feel better lying on your back on a firm surface with a pillow under your knees. Another option is lying on your side with a pillow between your knees to keep your back straight. Also, you might find that a recliner chair is helpful.
  • Take it easy, but do not lie in bed for longer than 2 days because this has been shown to actually worsen the condition. Do activities you are able to tolerate, and do not expect to feel better overnight.
Other Therapy

You may receive special instructions from your doctor on dealing with back pain. Some suggest complete bed rest—getting up only to go to the bathroom. Others suggest you sleep on the floor or put a board under your mattress for support. Some will tell you to use heat, others cold. You may also get a sheet with pictures of  back exercises   you are expected to start when the pain improves. (These patient education sheets come from different sources and may have conflicting information.)

Current research recommends that you stay active, within limits imposed by your pain. If you can avoid reinjuring yourself, you should try to stay at work. If the pain forces you to rest, do so, but avoid staying in bed just because you have back pain.

If you are not improving after a week or 10 days, talk with your doctor about alternative therapies  . Millions of people get some relief by visiting physical therapists, osteopaths, and chiropractors. Others find that relaxation techniques and acupuncture   work for them.

Recent studies in Europe and Scotland show that injection of botulinum toxin (BOTOX ®) gives relief to many people suffering from long-term sciatica. There are, thus far, not enough cases or completed studies to make this more than an experimental procedure.

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Follow-up

Common sense should tell you what to do.

  • Continue the simple home care measures for easing the pain. Use pain medicines, both over-the-counter and those prescribed for you by your doctor.
  • Avoid reinjuring yourself. Pain will be your guide. If you hurt too much, back off on what you are doing and rest. Go slowly, if necessary, but try to keep active.
  • Using a cane or a crutch for support will be helpful until the pain is under control.
Prevention
  • Proper lifting techniques in keeping your back straight while bending your knees to pick up items often help avoid mechanical back problems.
  • Keep flexibility and muscle tone by performing stretching exercises. These will help keep your back from bothering you. Maintaining your weight within your recommended limits for your height will go a long way to maintaining a healthy back as well.
Outlook

Most of the time, the pain associated with sciatica goes away in days to weeks. Pain can become more chronic in a small number of people, leading to some disability. Sciatica tends to reoccur frequently, sometimes without warning.

As your back is recovering, avoid twisting your back while bending at the same time because this move may aggravate your healing   back and may slow your recovery.

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