Sciatica advice- how to ease the pain, am in agony?
Discussion
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After 6 years of permanent back pain, although not severe enough to keep me awake for more than once or twice a month, It has gone away with a pill.
Further, for years I've had severe sciatica two or three times a month, which meant me sleeping in a chair for two or three nights for each attack. I was taken seriously by a new doctor to our practice, one who had not been beaten into submission by the system.
He put me on amitriptalene and within a couple of seeks the permanent back pain had gone and the sciatica had a lower frequency of attacks. Now once a month.
Further, I had an MRI which identified my problem and I went to an NHS physio. Their remit is to change lifestyle for a permanent lowering of pain. I have been twice and have been given a series of exercises which, whilst they haven't repaired my problem, have lowered the pain.
I am to be sent to a back clinic (no idea of the format) for six periods, the first being assessment and five being exercises and such. If I improve sufficiently I will be let loose on the world to make my own arrangements for exercise, presumably meaning joining a gym.
I broke three vertebrae in 1978; I was thrown against a table fixed to the floor. If I'd had proper treatment then I might have been spared the pain but I was macho and carried on in pain. An idiot, I know now. I've had sciatica on and off since then, the frequency of problems increasing over the years. I've had dozens of physio sessions which have eased the pain for a short period. I've been to a chiropractor, 12 sessions, which made the pain worse.
For the first time I have had an extended period where there has been an improvement.
I'll never be 'better' and might have to have something different done in later years. But the NHS has, so far, helped me no end.
Don't give up.
Further, for years I've had severe sciatica two or three times a month, which meant me sleeping in a chair for two or three nights for each attack. I was taken seriously by a new doctor to our practice, one who had not been beaten into submission by the system.
He put me on amitriptalene and within a couple of seeks the permanent back pain had gone and the sciatica had a lower frequency of attacks. Now once a month.
Further, I had an MRI which identified my problem and I went to an NHS physio. Their remit is to change lifestyle for a permanent lowering of pain. I have been twice and have been given a series of exercises which, whilst they haven't repaired my problem, have lowered the pain.
I am to be sent to a back clinic (no idea of the format) for six periods, the first being assessment and five being exercises and such. If I improve sufficiently I will be let loose on the world to make my own arrangements for exercise, presumably meaning joining a gym.
I broke three vertebrae in 1978; I was thrown against a table fixed to the floor. If I'd had proper treatment then I might have been spared the pain but I was macho and carried on in pain. An idiot, I know now. I've had sciatica on and off since then, the frequency of problems increasing over the years. I've had dozens of physio sessions which have eased the pain for a short period. I've been to a chiropractor, 12 sessions, which made the pain worse.
For the first time I have had an extended period where there has been an improvement.
I'll never be 'better' and might have to have something different done in later years. But the NHS has, so far, helped me no end.
Don't give up.
I've just finished the course of back classes as above. Nothing dramatically different from what I'd been doing before but strict limits and lots of different exercises. They were aimed at muscle building, back strengthening and flexibility.
I went nine days without sciatica the week before last and am now on 8 days. I've had no 'serious', ie keeping me awake at night, pain for nearly a month. I still take the occasional paracetomol but now often precautionary. I mean I know when I've done something that will hurt later.
I feel so much better. It is not only the lack of pain but being able to sleep for a full night.
I've now got half-price membership of a local gym via the NHS with a personal trainer with some expertise with back problems. After 6 months it is full price, concession in my case 'cause of age, so only goes up to 65% of full price.
You have to work at it though. Some of those in the back classes don't do everything they are told or else don't do all the reps. You can see the expression of despair on the faces of the physios.
One warning I got was that I should still follow the 'coping systems' I used for the last three years, like not sitting for more than 40 mins at a time and not walking for more than an hour without a rest.
I've also splashed out on a decent pair of walking shoes and I've got the feeling they help.
So for the first time in ages I've not believed that I will gradually get worse, the pain will be more frequent and that I'd be taking more and more painkillers.
Magic!
So don't give up trying for a result.
I went nine days without sciatica the week before last and am now on 8 days. I've had no 'serious', ie keeping me awake at night, pain for nearly a month. I still take the occasional paracetomol but now often precautionary. I mean I know when I've done something that will hurt later.
I feel so much better. It is not only the lack of pain but being able to sleep for a full night.
I've now got half-price membership of a local gym via the NHS with a personal trainer with some expertise with back problems. After 6 months it is full price, concession in my case 'cause of age, so only goes up to 65% of full price.
You have to work at it though. Some of those in the back classes don't do everything they are told or else don't do all the reps. You can see the expression of despair on the faces of the physios.
One warning I got was that I should still follow the 'coping systems' I used for the last three years, like not sitting for more than 40 mins at a time and not walking for more than an hour without a rest.
I've also splashed out on a decent pair of walking shoes and I've got the feeling they help.
So for the first time in ages I've not believed that I will gradually get worse, the pain will be more frequent and that I'd be taking more and more painkillers.
Magic!
So don't give up trying for a result.
Funny, I was going to bump this thread this morning and Derek has got there ahead of me.
My back got a lot worse just over a week ago so I went into hospital yesterday for facet joint and nerve block injections. All ok straight after as the anaesthetic did its job. This morning the pain is back but apparently it should reduce as the steroid takes effect.
My back got a lot worse just over a week ago so I went into hospital yesterday for facet joint and nerve block injections. All ok straight after as the anaesthetic did its job. This morning the pain is back but apparently it should reduce as the steroid takes effect.
julian64 said:
Hi what medications you on?
Should be a combination of NSAIDs/Pure painkillers/Neuropathics/Muscle relaxants depending on your ability to take
I can take more or less anything. I have Dyclofenec Sodium (NSAID) which I have taken this morning, wondering whether to also take Paracetamol or IbuprofenShould be a combination of NSAIDs/Pure painkillers/Neuropathics/Muscle relaxants depending on your ability to take
Edited by bad company on Wednesday 22 June 09:09
Another one here in agreement with Derek Smith.
Co-codamol will do nothing for nerve pain. I was on that, dihydrocodeine, naproxen, paracetamol, ibuprofen, amatriptyline, and the biggest dose of diazepam you have ever seen, and probably other stuff. When none of it worked, they upped the doses beyond the recommended, because I'm a big guy so maybe I just needed a bit more. Pathetic approach by the GP! I lost a week of my life where I was so utterly spaced out, I have no recollections at all, but still couldn't get out of bed without screaming because none of those drugs actually worked. Amatriptyline was probably a bit useful eventually. My breakthrough came when I saw a different GP, and she took me off all that nonsense and put me on gabapentin, under close supervision. 3 days and I was running and skipping. Nothing fixed, but it's the proper type of pain blocker for nerve pain, and if you can't feel the pain, you can move, exercise and start recovering with physio.
Eventually, I came off the gabapentin, and just pop a couple of ibuprofen when I've been sat at my desk all day.
After I was back on my feet, I mucked about for ages with physio, some of it helping, but not really making progress. It felt like guesswork on their part. Some of the exercises I felt made things worse, but couldn't really prove it as it was all a bit variable.
I didn't believe they knew what the problem was. I was right.
You'll make no significant progress until you get an MRI. If you can't get one on the NHS, pay for one. Mine, with consultation before and after was about £750. They'll give you the images, which will miraculously help your physio and GP and everyone else who ever sees them to actually give you the correct exercise to do. You may even end up with a surgical consult. I did, but never got as far as surgery as physio helped.
Don't hesitate, demand or pay for an MRI now and that will be Day 1 on your road to proper treatment and therefor recovery. Until then, everyone is guessing. Just because they're qualified, doesn't give them x-ray eyes.
I have since lapsed to the point where I'm in constant mild-medium pain again, but that's my fault. I don't have time to exercise at all. If I kept up the physio and exercise I'd be fine, but it's funny how quickly you accept chronic pain as part of daily life because it's easier than finding time to fix it. Anyway, that's my problem.
So, MRI (don't think, just do it) and don't expect the wrong drugs to do any good. GPs are very much "here, have some painkillers and go away". with back pain because it's such a common complaint with a million different varieties, so stay under the care of a specialist.
Co-codamol will do nothing for nerve pain. I was on that, dihydrocodeine, naproxen, paracetamol, ibuprofen, amatriptyline, and the biggest dose of diazepam you have ever seen, and probably other stuff. When none of it worked, they upped the doses beyond the recommended, because I'm a big guy so maybe I just needed a bit more. Pathetic approach by the GP! I lost a week of my life where I was so utterly spaced out, I have no recollections at all, but still couldn't get out of bed without screaming because none of those drugs actually worked. Amatriptyline was probably a bit useful eventually. My breakthrough came when I saw a different GP, and she took me off all that nonsense and put me on gabapentin, under close supervision. 3 days and I was running and skipping. Nothing fixed, but it's the proper type of pain blocker for nerve pain, and if you can't feel the pain, you can move, exercise and start recovering with physio.
Eventually, I came off the gabapentin, and just pop a couple of ibuprofen when I've been sat at my desk all day.
After I was back on my feet, I mucked about for ages with physio, some of it helping, but not really making progress. It felt like guesswork on their part. Some of the exercises I felt made things worse, but couldn't really prove it as it was all a bit variable.
I didn't believe they knew what the problem was. I was right.
You'll make no significant progress until you get an MRI. If you can't get one on the NHS, pay for one. Mine, with consultation before and after was about £750. They'll give you the images, which will miraculously help your physio and GP and everyone else who ever sees them to actually give you the correct exercise to do. You may even end up with a surgical consult. I did, but never got as far as surgery as physio helped.
Don't hesitate, demand or pay for an MRI now and that will be Day 1 on your road to proper treatment and therefor recovery. Until then, everyone is guessing. Just because they're qualified, doesn't give them x-ray eyes.
I have since lapsed to the point where I'm in constant mild-medium pain again, but that's my fault. I don't have time to exercise at all. If I kept up the physio and exercise I'd be fine, but it's funny how quickly you accept chronic pain as part of daily life because it's easier than finding time to fix it. Anyway, that's my problem.
So, MRI (don't think, just do it) and don't expect the wrong drugs to do any good. GPs are very much "here, have some painkillers and go away". with back pain because it's such a common complaint with a million different varieties, so stay under the care of a specialist.
I have suffered with back pain on and off since I was 18! I bent down to pick up a tray of glasses from the washer in the pub one evening and got stuck and couldn't move through pain! Eventually it released and I carried on with my evening, went home and sat on the floor watching the television when I got stuck and couldn't move again! I ended up off work for 12 weeks etc, the prevailing theory was I had slipped a disc that had moved back or something I don't entirely recall owing to the pain killers and actual pain!
Ever since it has been on and off, there was a new prevailing theory that I had mild scheuermann's disease. However a specialist looked at some terribly blury s
t xrays and dismissed it even though both my physio and GP disagreed with his results. I was re-referred to someone else but my MRI's were lost and the appointment cancelled. It then settled down for it's usual 6 month quiet period, it is now on the return, I am currently sat here typing this out in agony, my foot has pins and needles the lot. Really should get back to my GP to go through all the usual again!
Ever since it has been on and off, there was a new prevailing theory that I had mild scheuermann's disease. However a specialist looked at some terribly blury s
t xrays and dismissed it even though both my physio and GP disagreed with his results. I was re-referred to someone else but my MRI's were lost and the appointment cancelled. It then settled down for it's usual 6 month quiet period, it is now on the return, I am currently sat here typing this out in agony, my foot has pins and needles the lot. Really should get back to my GP to go through all the usual again!Having been through really bad back pain caused by prolapsed discs I'd tend to be wary of some of the advice I've seen others give about stretching.
If Sciatic pain or back pain is caused by a prolapsed disc then it needs time to heal.
I would not do stretching or exercise that cause pain until the injury has had time to heal.
For prolapsed discs it can take 1-2 months to heal, then you should start a program to improve core strength and flexibility. This will reduce the chance of it happening again.
But if you are on the floor in agony I'd not try sit ups.
Whilst recovering you want to be moving as much as the pain allows. Gentle swimming, moderate walks and simple stuff. Avoid sitting. Doing Squats and flexion should be avoided until you have allowed sufficient time for the injury to heal and then approached cautiously. Anti inflamatory drugs and painkillers help you to make moderate movements, but don't use them to block pain the overdo it.
Most times a prolapsed disc will sort itself out, but in other cases if it's prolonged past a few months or happens multiple times you might be a candidate for surgery. I had maybe 5-6 prolapse episodes over 6 years and had surgery a few months ago. It's no magic bullet but things are mostly improved. Now I've got to work on my core strength and movement without putting undue pressure on that area. Hopefully get to ski again this winter.
If Sciatic pain or back pain is caused by a prolapsed disc then it needs time to heal.
I would not do stretching or exercise that cause pain until the injury has had time to heal.
For prolapsed discs it can take 1-2 months to heal, then you should start a program to improve core strength and flexibility. This will reduce the chance of it happening again.
But if you are on the floor in agony I'd not try sit ups.
Whilst recovering you want to be moving as much as the pain allows. Gentle swimming, moderate walks and simple stuff. Avoid sitting. Doing Squats and flexion should be avoided until you have allowed sufficient time for the injury to heal and then approached cautiously. Anti inflamatory drugs and painkillers help you to make moderate movements, but don't use them to block pain the overdo it.
Most times a prolapsed disc will sort itself out, but in other cases if it's prolonged past a few months or happens multiple times you might be a candidate for surgery. I had maybe 5-6 prolapse episodes over 6 years and had surgery a few months ago. It's no magic bullet but things are mostly improved. Now I've got to work on my core strength and movement without putting undue pressure on that area. Hopefully get to ski again this winter.
I was given a load of stretch exercises to do by my physio too. You do need to strengthen the core muscles around the disc if it's prolapsed (mine is too) as it is the core muscles which provide the support to the vertebrae and stop the disc bulging out against the nerve.
However, the disc can bulge out in various different ways.
Pre-MRI my stretches were pushing it out further. Obviously this hurt and I was advised to not stretch "up to the pain point, but not into it" which just didn't work. Exercises which were supposed to "open up" the back side of the two vertebrae to provide space for the disc and relief of pressure (i.e. bending forward exercises) were actually, in my case, causing the front sides of the vertebrae to squish the disc out even further.
One MRI later, it was clear I needed to stretch in a totally different direction. Basically doing what I call (pardon the expression) C*ck-Thrusts.
The opposite of bending forward. Shifting my entire pelvis forwards instead, pulling the disc away from the nerve. Counter-intuitive to the physio, but can't argue with the MRI or the results.
The long and short of it is, until you have a look inside, it's all guesswork, and can do as much damage as good, regardless of how professional and experienced the team of specialists are who are issuing the exercise instructions. My physio is on various back pain specialist panels in our area, and still got it wrong. I don't blame her at all. As soon as she had MRI results in her hands, she changed the exercises and we made rapid progress.
However, the disc can bulge out in various different ways.
Pre-MRI my stretches were pushing it out further. Obviously this hurt and I was advised to not stretch "up to the pain point, but not into it" which just didn't work. Exercises which were supposed to "open up" the back side of the two vertebrae to provide space for the disc and relief of pressure (i.e. bending forward exercises) were actually, in my case, causing the front sides of the vertebrae to squish the disc out even further.
One MRI later, it was clear I needed to stretch in a totally different direction. Basically doing what I call (pardon the expression) C*ck-Thrusts.
The opposite of bending forward. Shifting my entire pelvis forwards instead, pulling the disc away from the nerve. Counter-intuitive to the physio, but can't argue with the MRI or the results.The long and short of it is, until you have a look inside, it's all guesswork, and can do as much damage as good, regardless of how professional and experienced the team of specialists are who are issuing the exercise instructions. My physio is on various back pain specialist panels in our area, and still got it wrong. I don't blame her at all. As soon as she had MRI results in her hands, she changed the exercises and we made rapid progress.
With all due respect ignore tartans advice.
Gabapentin is a neuropathic with quite a lot of similarities to amitriptyline that he was already taking. Some people do better on one of the three main ones (pregabalin is the third). But his advice to switch to the miracle gabapentin is rubbish as you can't really tell when you start a patient which they'll react best to. Simply a case of trying the three neuropathic and finding out but giving each one a decent go..
his attempts to rubbish the other classes of tablets (painkillers NSAID and muscle relaxants) is just as daft, because for some people they are all that's needed or indeed a single, or combination of all three/four. All have side effects and his experience of them is only his, and doesn't transfer over to you.
The MRI is a total waste of your money in the first eight weeks unless you have clinical signs pointing to nerve compression because the majority of sciatica is a single insult and eight weeks waiting for the nerve to calm down. MRi's are reserved for people not settling over a period of time (and therefore have continual insult to a nerve 'unstable disc herniation') on normal treatment of gentle exercise and the above, or with localising signs.
The vast majority of people who go privately to have MRIs done simply see age related changes in the spine (which we all have) and rarely show any impingement unless there are clinically localising signs (£800 down the toilet better spent on honing fuel)
Beware of sensation or motor loss/loss of bladder control, or saddle anaesthesia. These are red flag signs and if you get any of them ->A&E
This is pretty good, and so is your local GP although because he tells you something you don't want t o hear it doesn't make him/her wrong
http://www.nhs.uk/conditions/Sciatica/Pages/Introd...
Gabapentin is a neuropathic with quite a lot of similarities to amitriptyline that he was already taking. Some people do better on one of the three main ones (pregabalin is the third). But his advice to switch to the miracle gabapentin is rubbish as you can't really tell when you start a patient which they'll react best to. Simply a case of trying the three neuropathic and finding out but giving each one a decent go..
his attempts to rubbish the other classes of tablets (painkillers NSAID and muscle relaxants) is just as daft, because for some people they are all that's needed or indeed a single, or combination of all three/four. All have side effects and his experience of them is only his, and doesn't transfer over to you.
The MRI is a total waste of your money in the first eight weeks unless you have clinical signs pointing to nerve compression because the majority of sciatica is a single insult and eight weeks waiting for the nerve to calm down. MRi's are reserved for people not settling over a period of time (and therefore have continual insult to a nerve 'unstable disc herniation') on normal treatment of gentle exercise and the above, or with localising signs.
The vast majority of people who go privately to have MRIs done simply see age related changes in the spine (which we all have) and rarely show any impingement unless there are clinically localising signs (£800 down the toilet better spent on honing fuel)
Beware of sensation or motor loss/loss of bladder control, or saddle anaesthesia. These are red flag signs and if you get any of them ->A&E
This is pretty good, and so is your local GP although because he tells you something you don't want t o hear it doesn't make him/her wrong
http://www.nhs.uk/conditions/Sciatica/Pages/Introd...
I take your point Julian but in my case the MRI confirmed a slipped disc which was good to know about so IMO money well spent. The spinal consultant asked for the MRI so I guess he knew he needed one.
As I said I am still taking Dyclofenec Sodium, is there anything else I should be using post the facet joint and nerve block injections yesterday?
As I said I am still taking Dyclofenec Sodium, is there anything else I should be using post the facet joint and nerve block injections yesterday?
As my specific personal experience has been shot down in flames, my generalised, non-specific advice is: take your treatment into your own hands, and don't trust your GP or the NHS script, because it is pure trial and error, and will quite possibly let you down. Don't take stabs at the solution and live in hope (and pain). Use all the diagnostic tools available, and if you are denied access to them, do it anyway, because the idea that doctor knows best is a total fallacy. They don't. Nor do they care that they don't, because it's all a numbers game. Prescribing drugs in the textbook order will fix some of the people some of the time. That's good enough for their targets. MRIs are not useful in x% of similar cases, and therefor you don't need one. B*llocks.
The only person in the entire system who sees you as an individual is you. Until you get your wallet out. Then things miraculously change.
The only person in the entire system who sees you as an individual is you. Until you get your wallet out. Then things miraculously change.
TartanPaint said:
As my specific personal experience has been shot down in flames, my generalised, non-specific advice is: take your treatment into your own hands, and don't trust your GP or the NHS script, because it is pure trial and error, and will quite possibly let you down. Don't take stabs at the solution and live in hope (and pain). Use all the diagnostic tools available, and if you are denied access to them, do it anyway, because the idea that doctor knows best is a total fallacy. They don't. Nor do they care that they don't, because it's all a numbers game. Prescribing drugs in the textbook order will fix some of the people some of the time. That's good enough for their targets. MRIs are not useful in x% of similar cases, and therefor you don't need one. B*llocks.
The only person in the entire system who sees you as an individual is you. Until you get your wallet out. Then things miraculously change.
I have some sympathy with that. When I first saw my GP it was made very clear that there was no chance of an MRI on the National Health until and unless I had been in pain for some weeks (blame the budgets not the GP). So I would have had to wait at least 6 weeks for a referral to a specialist then another say 12 weeks to see him. If as in my case the specialist wanted an MRI that will be another 6 weeks or so waiting for that so all this is BEFORE I would even have go onto the waiting list for the treatment.The only person in the entire system who sees you as an individual is you. Until you get your wallet out. Then things miraculously change.
Thank god I am able to pay to short cut all of the above. I was in agony and couldn't even tie my shoe laces.
My problem, and it is a big one, I tend to lose concentration. I'll follow all the advice for a few week and then slip, just the one day which goes on for a week. I'll start again but won't continue. Then the pain will come back and I'll start all over again.
With appointments at the hospital I was being monitored and my physio was well pleased with my improvement. I'll be going to a local gym three times a week for an hour a time. That'll be enough to keep things at bay until the problem gets a lot worse (which it will, I've been promised).
I've got my wife on side. She's joining as well and will 'encourage' me to attend regularly.
With appointments at the hospital I was being monitored and my physio was well pleased with my improvement. I'll be going to a local gym three times a week for an hour a time. That'll be enough to keep things at bay until the problem gets a lot worse (which it will, I've been promised).
I've got my wife on side. She's joining as well and will 'encourage' me to attend regularly.
TartanPaint said:
MRIs are not useful in x% of similar cases, and therefor you don't need one. B*llocks.
Exactly. Even if you've paid for an MRI and it comes back showing you don't have a slipped disc, that in itself tells you just as much as if it came back as positive. At least you're getting closer to the cause, rather than sitting around taking painkillers, hoping it will go away.I work in MRI in the NHS and there was a feeble attempt made to convert all lumbar spine x-ray requests into MRIs for chronic back pain, but the simple fact is there isn't enough capacity to scan everybody, so they are reserved for certain cases, as described above. But if you can afford the MRI scan privately, just go for it, it's an excellent test.
Not sure I have much to add to what has already been posted but many posts mirror my own experiences over the last few years....... 3pm today I had a spinal nerve root block..........not sure if this has already been mentioned but happy to update once / if it makes a difference to my problems. In the meantime all the best to those that are suffering.
eta I see Bad Company has already covered this...sorry.
Can I just add that if taking various painkillers you may want to look at taking Omeprazol or similar also.
eta I see Bad Company has already covered this...sorry.
Can I just add that if taking various painkillers you may want to look at taking Omeprazol or similar also.
Edited by alfie2244 on Wednesday 22 June 22:43
alfie2244 said:
Not sure I have much to add to what has already been posted but many posts mirror my own experiences over the last few years....... 3pm today I had a spinal nerve root block..........not sure if this has already been mentioned but happy to update once / if it makes a difference to my problems. In the meantime all the best to those that are suffering.
eta I see Bad Company has already covered this...sorry.
Can I just add that if taking various painkillers you may want to look at taking Omeprazol or similar also.
Let us know how you feel tomorrow.eta I see Bad Company has already covered this...sorry.
Can I just add that if taking various painkillers you may want to look at taking Omeprazol or similar also.
Edited by alfie2244 on Wednesday 22 June 22:43
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