Sciatica: really awful pain

[Jux]

DH has sciatica and was told initially that it normally cleared up in about 6 weeks, and here's a prescription for strong codeine.....got him so bombed out that he couldn't do anything and didn't really deal adequately with the pain.

Now he's on Naproxen, 250mg, and Omiprazole, 20mg (I think twice a day). He is still in so much pain that he will cry when he first wakes and gets out of bed. He cannot get comfortable sitting down no matter the height of the chair, he is not comfortable in bed lying down either. He says it is slightly less awful when he walks about. It's been months, I'm not exagerating, months, since he sat on the sofa, let alone relaxed.

He is desperate.

Can anyone recommend any serious painkillers. I have suggested he ask our gp about zydol (?) but otherwise I am at a loss. He doesn't want opiates if he can avoid them. He just wants it to stop hurting without rendering him unconscious!

Has he had any physio? I had terrible sciatica after giving birth to dd, in agony for weeks but couldn't take really sting painkillers as I was bf. I had physio with acupunture and it helped immediately within a few sessions I was walking around much more comfortable. It's not cheap but made a huge difference for me very quickly so was worth every penny.

I agree with physio. And cold packs. I had some nerve block injections that took the edge off the leg spasms. He could ask the doc about taking Neurontin, it is used for nerve pain, which is what your dh is having. I found Tramadol helped my leg pain (from sciatic nerve) more than codeine, And yes to the Physio if his doctor thinks he is ready for it.
Only yesterday I sat on my rollator in the middle of the kitchen and shed a few tears, trying to make a cup of tea and toast was so difficult.

Huge sympathies to your DH OP.

I've had sciatica twice & it can end up being very debilitating indeed The first time I had it, I had physio which helped a bit but my turning point was Bowen treatment. The second time I had it, I didn't bother with the physio but contacted a Bowen practitioner & she cured me within 2 sessions. If you can afford it, I'd certainly recommend it.

hope this helps

PS He also can ask to see a Pain specialist, they manage pain better.

It was a pain doctor who gave me the nerve block injections.

I would also suggest acupuncture.

If you have a read through the back pain thread you will see he is very much not alone. As he knows codeine isn't that effective at dealing with nerve pain. Naproxen 250mgs could easily be doubled, this might help a bit because it's an anti inflammatory. There are another group of meds which are very effective against nerve pain although originally intended for other purposes. Amitriptyline is an old fashioned anti depressant and in very small doses helps both sleep and nerve/leg pain. It's taken at night, 10-50 mgs. It takes a while to be effective and it causes you to feel sleepy in the morning for a while but this passes so you really have to commit to it. Gabapentin is an epilepsy med and taken in three doses through the day also causing tiredness initially. You can takes both, i do. Paracetamol is still worth taking, too.

As others say physio can be helpful but IMO only when there is a clear diagnosis and for that he needs an MRI. If he has a large disc prolapse then physio could make it even worse. I sympathises with the sitting, I won't tell you how long it is since I sat comfortably . Push the doctors hard for a scan is he hasn't had one recently, severe nerve compression can be an emergency even.

Hope that helps, do join us on the back thread for lots more.

And yes, injections can help but only if there is a scan to see where the problem is.

Drugs like codeine and tramadol do stop making you so dopey eventually, it's worth trying because such agony that you cry in the morning is unacceptable. I love heat,surgically attached to my hottie. My DH brings me one with my tea in the morning to ease things a bit before trying to get up.

Massage can help if there are deep muscles spasming but you need the right person. So there are lots of things to try. Getting some basic analgesia and a diagnosis would be something to discuss with the GP pretty urgently.

Yes to getting an MRI - he really needs one after so long in pain. Yes also to getting referred to the pain clinic.

I suffer with sciatica constantly due to 2 of my discs being damaged. The levels of pain vary but when it really flares up diclofenac, codeine and paracetamol work for me. I've tried lots of combinations over the last 20 years and this suits me the best.
I remember the Amitriptyline worked quite well a few years back.

When mine is at it's worst I can't sit on sofas/soft chairs. I use a dining table chair and support my back how I can.
I'm loathe to say it because I know it's not comfortable and painful but I have to keep moving, gentle exercise, even during flare ups - nothing special or strenuous obviously. I find when I sit still and rest it hurts more.
I also find something that puts light pressure on my lower back helpful - I use one of those tummy sucky in things - it doesn't effect how I can move or walk but it just feels tighter/better.

Thank you all! I shall try to answer you, and add info if necessary.

He tried amitriptyline early on, but didn't cope with the side effects. I'm sorry, I should have said but forgot (it was late when I posted).

I also should have said that I have ms and take meds for nerve pain, including low dose anti-ds and pregabalin. Maybe the gp has to try cheaper options first?

He hasn't had an MRI yet, but I will pass that on.

Bowen treatment is a good idea. I knew a practitioner once, many years ago. I wonder if it exists in Devon

He can try heat packs straight away as I have a couple. If that doesn't work, he can try frozen peas (cold packs work better for me, but hot baths... Go figure).

I shall tell him of Neurontin. He's not so keen on tramadol, as he reckons that will zonk him out. He has some diclofenac which was prescribed for something else which he could take.

Acupuncture, pain specialist, nerve block injections. I shall pass all this on to him, and also point him at the back pain thread.

Oh, and tummy sucky in things . Can you link to one of those, CarbeDiem?

Thank you all so much.

When you say he needs a dx, the gp did that when it started. Do you mean a dx from a specialist?

The word sciatica really isn't a diagnosis as such, it's like saying stomach ache without ascertaining what is causing the pain IYSWIM? From your description it does sound a lot like a disc at L4/5 but only a scan can see that ( or whatever else it is) so that is required for an actual diagnosis.

I would strongly urge retrying amitriptyline as the side effects do wear off. GP likely to try gabapentin before pregablin due to the cost differences. I actually prefer gabapentin [cheap date emoticon] . As before, all these meds have side effects and mostly the sleepiness really improves. With this pain the best pain relief is found in clever combining of different med groups plus Pacing activity ( google if unfamiliar but with m&s I'm sure you know loads of this stuff).

My mantra is rest,potter, rest when the pain is acute.

I have one of these which is very supportive though a bit bulky. And I find exercising in water is good for strength without any imact risks. I had a physio work out a programme but walking in water backwards and forwards is good.

Good luck with the GP, I'm cross for your DH this has rumbled on so long. My friends DH was weeping with pain,too. He had an MRI quite fast for the nhs and was called in the next day for an urgent discectomy. I'm definitely not saying that's always the best or right route but sometimes it's absolutely necessary. My SIL is currently hobbling on crutches but starting to benefit from a nerve block....there's a lot of it about.

And sorry, finally, finally, if he is working can he ask for an assessment for workplace adjustments? Employers are obliged to do this and may have to provide special desks, chairs etc.

You need to push for an MRI scan so that the medics can find out what is causing the pain. Is it a ruptured or bulging disc? If it's the former he will probably need surgery, if it's the latter then physio, such as the McKenzie Technique can help.

I found a TENS machine quite helpful when the drugs didn't do much for the pain.

During recovery from a disectomy, the pain treatment I had was two paracetomol every four hours, plus diazepam to prevent muscle spasm. The trick to stopping the pain from sciatica is to get the muscle out of spasm.

If this has been going on for months then he really does need to push for that MRI scan - it might be worth considering going private if necessary, it's a few hundred pounds but that is so worth it when the problem is fixed. I speak as someone who was unable to walk due to a ruptured disc.

Also, if he gets any incontinence at all, then you need to get him straight to A&E as an emergency. There is one spinal nerve (I can't remember which one) but if it becomes damaged by a disc rupturing/bulging, then there is a very short space of time to fix the damage before permanent incontinence is caused. This happened to a work colleague who damaged his disc getting out of a car and was left permanently disabled/incontinent as he didn't get treatment early enough.

Good luck.

I would suggest finding a private Physio who uses the 'dry needling' technique. It's done wonders for me, it will bring a degree of instant relief and continued treatments should cure it altogether. Not every Physio offers the technique but it's worth looking for one, it sounds hellish for your poor DH

The main this is physiotherapy and pain killers and keeping mobile.

Patients who have MRIs have worse outcomes.

Injections are best avoided and dry needling is completely bonkers.

"Patients who have MRIs have worse outcomes"

Now that is completely bonkers! Perhaps it's just those who have MRIs actually have a physical injury which needs an MRI diagnosis, instead of a lesser injury that the body can repair itself?

If you're going to make bonkers statements perhaps you should provide some medical evidence to back it up?

I have a similar back support as the one Matilda linked to. That and my rollator have really made moving around easier. Also, a shower chair, but you prob have that already, due to your MS.

Now that is completely bonkers! Perhaps it's just those who have MRIs actually have a physical injury which needs an MRI diagnosis, instead of a lesser injury that the body can repair itself?

Thank you - and a quick google brought up several medical journals disagreeing. here is just one example

As someone who has had a herniated disc with succesful surgery, I know I am biased, but an MRI scan saved me from months of extreme pain. It helps to know exactly what is causing the pain and that can only be ascertained with an MRI scan.

And without getting into an unseemly discussion, I simply wanted to know wtf was actually wrong with me and the whole thing wasn't in my head. I would have thought that most people want to know what is causing extreme agony.

A lot of physios will be very cautious about treating a spine without a clear diagnosis. Another poster on here went for an MRI for low back/ hip pain last year to find she had a large sarcoma in her sacrum. She was quite pleased she went, I think. ( Not wishing to scare the OP, simply pointing out the advantage of a diagnosis).

Jux - it's like this.
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I certainly didn't have a worse outcome from my first MRI - it finally proved I had real problems rather than everyone just putting my recurring sciatica, weakness and pain down to 'mechanical back issues' which was blamed on having a baby (They were partly right as it was the bastarding epidural that caused it)
Anyway without it I'd have been ignored and fobbed off a lot longer.

Thanks people!

MRIs don't worry me or him; we've both had at least one in our time - actually, I've had loads and my only gripe is no one shows me the resulting pictures. I want to see my brain!!

Anyway, turns out dh has an appt to see physio on Thursday, so I shall write a list for him of all your suggestions and he will ask about them. He's got the link to the back pain thread so he'll be reading that too.

My first MRI, 12 years ago, showed I had ms. I suppose that could be called a bad outcome , though like so many of you, I was delighted to know that all those symptoms were real and I wasn't a) barking, or b) lazy and feckless

Oh, Matilda, thanks for the advice re work. Sadly he is a self-employed guitarist and has to jump about and perform, as well as load and unload heavy equipment etc. Both gp and physio know this, and if they haven't been able to stop him then I have no chance! The start of the year has been fairly quiet but he's getting busier now. He'll do himself a permanent injury if he's not careful.

Sorry to raise a zombie thread but I'm due an MRI for extreme sciatic pain in a months time. I'm also fat. I'm scared that I won't fit. Are the machines big? I'm also scared of getting stuck. When do you get the results. I can barely walk.

Hi Look, sorry you are in such pain. Can I suggest you call the hospital department and ask about the type of machine and any size restrictions? The cylinder you lie in is quite narrow, I won't lie, so there may not be a great deal of additional space once you are in. I'm sure this must be an issue for many people every day so just ask. There is such a thing as an open MRI scanner but they aren't available everywhere.

The results are usually available after two weeks though if there was anything urgent it would be sooner. The person who referred you should arrange a follow up appointment to discuss the findings and a management plan. If it was a hospital consultant you could phone now to arrange this for a couple of weeks after the scan.

Thanks for replying Matilda. It was arranged by my GP last week. I went as an emergency as was still in agony. He was doing his usual fobbing me off with painkillers when I mentioned how sick I was of being woken up by my leg when it became restless and had a fizzing sensation. He referred me there and then. He told me it might be months before my appointment came through so I was quite panicked and shocked when the letter arrived 2 days later for an appointment next month. I have physio before this appointment and am dreading that too. Everyone's just going to tell me it's all my own fault because I'm fat. I've dropped to a size 26 from a 32 but it's hard. Now that I'm less mobile I'm fecked. I'm scared of ending up disabled.