I don't know much of anything about sciatic pain, but I'm sending you as much good energy for healing as I can.
1. Massage Therapist
2. Pain Management Therapist (if you're not seeing one yet)
I hope you can get this resolved. Chronic pain sucks.
gingerly hugs offered.
Massage sounds better now - the PT mentioned that it might be that the nerve is "sticking" rather than being squeezed, and showed me some exercises for "mobilizing" it. I tried them when I last had spasms, and it seemed to help (though it hurt!).
But before... sometimes, I have no pain, none - and other times, I have awful, cramping, constant "I could scream!" pain. And other times, a nasty ache. I couldn't see how massage would help. But if it gets the nerve "unstuck" without as much pain as the exercises, I'm all for that.
My mom had very good results with a chiropractor/osteopath. Might take a few visits but if you get a good doc, should help.
That said, either heat or ice is something I would try.
Good luck and my sympathy.
Nod. I thought heat was helping, but now I'm not sure. I could try ice, I guess. And, I did manage to get the spasms to stop last night - there might be hope.
I have a bit of experience with this sort of thing. First up, if it really is nerve pain such as sciatic nerve twanging, painkillers and anti-inflammatories are unlikely to do a lot for it directly. If there's inflammation associated with it (e.g. the sciatic nerve is twanging specfically because something else near it it is damaged/inflamed and that something else is twanging on the sciatic nerve) then it might help, a bit. Can't hurt to try, but don't hold your breath on it fixing it.
For me, I find that treatment by an osteopath really helps. If you've not met them, an osteopath is kind of like a gentler version of a chiropractor - they do similar manipulative stuff, but add a LOT more massage first to loosen things up before starting with the bonecrunching. That'd be what I suggest you try first.
I've heard (from the doctors I saw at a chronic pain management clinic some years ago) that for pain that's specifically nerve pain there are some anti-depressants that for some mysterious reason help where normal painkillers won't. If you have no joy with an osteopath, try asking a doctor (ideally, one who tries to keep up with current research, to some degree) about the anti-depressant for nerve pain thing. I don't know a lot about it, but it might be worth investigating if the osteopath option doesn't work for you.
My spouse E's pain is primary nerve pain, and Lyrica changed his life -- turned him from Basically Disabled to Basically Not Disabled. He recently added another one of those seizure-meds-turned-nerve-pain-meds (can't remember the name), and it helped even more.
Can you choose your physical therapist? Because you might want to try another one. I would definitely recommend a manual physical therapist: http://www.aaompt.org/
. I went to a place in Austin when I dislocated my shoulder, and it definitely made a difference in my healing.
It dovetailed nicely with my Pilates training--I felt very much like I was getting the same story from both, and that the PT had a deep understanding of movement. (That's actually pretty rare for a PT in my experience. A lot of PTs seem to think muscles are static, and they think programatically about your treatment. I found the manual therapists to be much more personalized.)
I recently had back pain for several weeks, maybe a month, and I resolved it by adjusting the way I sleep--but this wasn't sciatic pain. However, I do recognize exactly how you experience your pain, and I sympathize--constant pain, even in the background, is wearing. You might want to think more about the ergonomics of your sleeping situation. (I'm assuming you've already looked at your work arrangement.)
Acupuncture or a chiropractor might help in the short term.
Well, I might end up trying that - but I only had three sessions with my PT. While the stuff he thinks might help alleviate the pain are worthless, the exercises I was doing were interesting - I found them surprisingly hard to do in good form, and I thought I felt something changing.
There was one kind of like sideways rowing where I kept having to check my right foot - it didn't want to stay pointed forward. (Technically, the PT instructor checked my foot - I didn't even notice I was moving it!)
Which, hey, good news, but so far, not enough, and by the way *ouch*. But yesterday, I managed to stop the spasms. I feel a bit more hopeful.
My hip pain is (mostly) trochanteric bursitis, not sciatica. But the thing that helps it the most is icing it -- every night when it's bad, off and on for most of the evening. NSAIDS help too, but I can't take them very often (they do bad things to the rest of my body). And gentle stretching helps -- not the bursitis itself, but the muscle spasms that tend to build up around it when I resist the pain. Using a cane is not out of the question either.
FWIW, YMMV, et al.
Oh, and: Sciatica is sometimes actually spinal stuff, a herniated disc or something of that nature. My mom was crippled by sciatica in her 40s; she had a laminectomy and never had another day's trouble.
Nod. I don't think there's any bone involvement, but we haven't really dug in yet. I did find that, surprisingly, some of my "nerve mobilization" exercises seem to help during the spasms. They hurt like hell, mind you - but the pain then transfers down the length of the sciatic and the muscles stop spasming. I hope that continues to hold.
As you know, I've been living with sciatica for ... hm ... something over 20 years now. Most of the time it's just minor background noise, but when it flares, it's disabling.
Of all the things I've tried, from drugs to exercise to various hands-on stuff, the only thing that reliably works to end a flare is a visit (or two, or three) to my chiropractor, who uses deep tissue massage, gentle spinal manipulation and a half hour on the TENS unit. (She's *not* a back-cracker, or one of those woo-woo chiros who wave weird devices over your back and talk bullshit at you). I'm not surprised that they're putting the unit on the small of your back; that's where the nerve bundle originates. The location where you *feel* the pain is not necessarily the site of the impingement. Nerves are weird like that.
I sometimes take ibuprofen, in moderate doses, while I'm working on the other stuff. That seems to take the edge off a bit, and settle any related inflammation. Narcotics don't do a thing for sciatic pain, IME,
Oh, and that pretzel-stretch. That helps a *lot*. I can actually feel it releasing the muscles that entrap my sciatic nerve.
Do you still have the Pete Escogue "Pain-Free" book? It might be worth digging it out and seeing what he recommends. ISTR the pretzel stretch was part of it, but there may have been other gentle exercises and stretches.
I so, so empathize about this. I know *exactly* how it feels, and it's very much Not Fun.
Sciatica is caused by a herniated disc in your lower back, which is probably why that's what your physical therapist is concentrating on. Since it's agonizing pain, I'd recommend getting a referral to an orthopedic surgeon who can give you an MRI and whatnot to let you know if it's a disc problem and give you better ideas how to handle it.
First off- chronic pain is exhausting, physically and mentally. That low-grade wariness of 'will this make it hurt?' takes up a sizable chunk of real estate in one's head.
Yeah. For me, with the Theoretical Shoulder, I've found that getting ahead of the pain can make a real difference. If I wait until it flares up badly the meds take longer and seem to help less. *insert frowny face here* I am not wild about needing meds to function but you plays the hand you get, you know?
I've had good but not entirely pleasant PT, pleasant PT that didn't seem to do a damn thing and PT that was neither helpful nor good. My experience is that PT can take a while to be useful but if it hits a point where it isn't helping- and your PT should be following up with you on that from appointment to appointment and adjusting what they do based in that feedback- but you may need to discuss changing PTs or modality of PT with your doctor.
I'd be about ready to push the doctor for some new avenue of treatment in your shoes.
Heh. You know, this is one reason I'm glad I posted about this. Yeah. I could have said to someone else that pain is exhausting. But somehow, I'm different :-). Thank you for reminding me.
It's not the needing the meds that bugs me, though... I've been on stimulants for over a dozen years; I think of those as my anti-suffering (versus anti-pain) meds. It's the side effects, one of which from the TMI category is something is already a bit of a plague for me, from time to time. And the other is the fog - which the stimulants don't necessarily pierce. But I've finally realized that I can fight past a fog better than I can ignore pain.
Oh that sucks. I've suffered from sciatica for years, I think it has to do with all the traveling I did (sitting on planes, long car rides, etc). And while I've had pain, never to the extent that you do. I mean, yeah it HURTS, sometimes very bad, and sometimes its that aching pain
For whatever reason, I've never told a doctor about it. I mean, I know what it is, and when it flares, I deal with it & it eventually subsides. So I've learned more from reading the comments than I knew before now. I think mine is the piriforms (?) others mentioned. And the pretzel twist has helped me, and stretching in general, plus digging my thumb (or something comparable) right into the center of the knot to get it to release. It hurts while I do it, but eventually I get some relief.
Here's hoping you get some relief soon.
Edited at 2011-01-31 11:52 pm (UTC)
A tennis ball is really useful for getting at piriformis knots--just put it on the floor and lie on it. Sometimes a golf ball will work, but I find them painful.