Carl Noe, M.D. Answers Questions On: Sciatica

No. Sciatica is pain resulting from irritation of the sciatic nerve, the large nerve that runs from the bottom of the spinal cord down the backs of the legs.

Although it originates in the lower back, sciatica is different from back pain because the pain radiates into the buttocks, hips, legs, and even the feet.

Common causes of sciatica include disc herniation, spinal stenosis, piriformis syndrome, and injury to the sciatic nerve.

Sciatica is very common and can be quite debilitating. Because it’s nerve pain – not pain secondary to tissue damage, which we’re all familiar with – it tends to be more severe and difficult to treat.

Sciatica typically occurs on one side of the body, often in conjunction with tingling, numbness, or weakness. It can sometimes be associated with difficulty emptying the bladder or controlling bowel or bladder function.

Heavy lifting and simultaneously lifting and twisting can be risk factors for developing both back pain and sciatica. Regular conditioning exercises such as walking can prevent recurrences.

In most cases, episodes of sciatica go away on their own; the body heals the underlying cause of the pain without any sort of invasive procedure. It’s a matter of whether people can ride out the pain for up to a month or more while that happens. 

Over-the-counter anti-inflammatory drugs such as ibuprofen and naproxen, as well as analgesics such as acetaminophen, can be as good as anything for treating sciatica.

Bed rest can actually prolong disability related to sciatica episodes, so trying to stay as active as possible during a flare-up is often the best pathway to recovery.

Yet, while treating sciatica conservatively with self-care for several weeks often relieves it, that’s not always the case.

If the pain becomes excruciating or extends below the knee, or if someone starts to experience numbness, weakness, or trouble with bladder or bowel function, that person should see a doctor.

UT Southwestern’s Pain Management Program at Eugene McDermott Center for Pain Management offers every nonsurgical therapy for sciatica and other spine conditions recommended in evidence-based guidelines.

Our interdisciplinary team for patients with chronic pain includes a pain management psychologist, a pain management physical therapist, and pain doctors like myself. The cores of the Pain Management Program are cognitive behavioral therapy – a structured form of psychotherapy – and physical therapy.

We have special expertise in spine-injection procedures for radicular (radiating) pain conditions like sciatica. These include nerve blocks and epidural steroid injections. We also offer radiofrequency ablation (the use of electricity to disrupt pain signals); neuroaugmentation (the use of electrical stimulation of the nervous system to manage pain); and non-opioid pain medications. 

These therapies enable many patients to stay functional while their bodies heal naturally, which is what happens in most cases.

We also offer pain management modalities such as biofeedback and trigger-point dry-needling therapy, manual therapy, and other complementary medicine approaches for patients being treated in the interdisciplinary program.

When appropriate, we refer patients with sciatica and other types of pain to our skilled colleagues in Neurology and Neurosurgery and Orthopaedics.