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Sciatica

Jul 25, 2019

Sciatica is pain going down the leg from the lower back, travel through buttock down the leg along the sciatic nerve, possibly with tingling, numbness or weakness. It is usually due to irritation and/or swelling of sciatic nerve at any location of the nerve anatomy. 

Medications:

  • Tab. Dolokind MR (Aceclofenac 100 mg, Paracetamol 325 mg, Chlorzoxazone 250 mg) 1 tablet twice a day for 5 days AND
  • Tab. Pantakind 40 (Pantoprazole 40 mg) 1 tablet a day for 7 days for gastric protection.
  • Gel Powergesic 2X (Diclofenac 2.32%, Methyl Salicylate 10%, Menthol 5% w/w) to be applied over painful area thrice a day for 7 days.
  • If patient is not diabetic or hypertensive – 6 days course of steroid – Tab. Zempred 4 (Methylprednisolone 4 mg)
    Day 1 – 2 tablets before breakfast, 1 tablet each after lunch, dinner and 2 tablets at bedtime (total dose 24 mg per day).
    Day 2 – 1 tablet before breakfast, 1 tablet each after lunch and dinner, 2 tablets at bedtime (total dose 20 mg per day).
    Day 3 – 1 tablet before breakfast, 1 tablet each after lunch, dinner and at bedtime (total dose 16 mg per day).
    Day 4 – 1 tablet before breakfast, 1 tablet each after lunch and at bedtime (total dose 12 mg per day).
    Day 5 – 1 tablet before breakfast and at bedtime (total dose 8 mg per day).
    Day 6 – 1 tablet before breakfast (total dose 4 mg per day).

Supplementary therapies:

  • Tab. Calcimax 250 (Calcium 250 mg with supplements) 1 tablet once a day for 30 days.
  • Tab. Mahagaba-M (Pregabalin 75 mg, Methylcobalamine) 1 tablet once a day with dinner for long standing pain. Titrate upto maximum dose of 150 mg twice a day.

General advice:

  • Consider traction – to relieve the vertebral compression due to osteoarthritis.
  • Advice stretching exercises.
  • Hot water fomentation to reduce muscle spasms.
  • Promote weight loss for overweight patients.

Investigations:

  • Serum creatinine – for dose adjustment in renal impairment.
  • X ray spine – Anterior posterior and lateral views to rule out skeletal deformity.
  • MRI Lumbar spine – to evaluate the spinal canal and rule out space occupying lesion or pressure effects.
  • Complete blood count – to rule our infective cause.
  • Urine routine – to rule out infection.
  • Prostate specific antigen (PSA) – to rule out the possibility of metastasis from prostate cancer.

Referral:

  • Physiotherapy for gentle exercises to promote early mobility and reduce muscle spasms.
  • Consider referral to spinal surgeon in case of nerve root compression on MRI scan.