13 tips for sleeping better with sciatica

From telegraph.co.uk

For people struggling with this excruciating nerve pain, a decent night’s rest is the thing they most need – and the hardest to achieve 

If you’ve ever had sciatica, it’s not the type of pain that you’re likely to forget in a hurry. “Pain is not always an accurate marker for the degree of injury, but nerve pain can be particularly unpleasant; sciatica has been described as like having toothache in your bottom,” says Aidan Spencer, an osteopath who frequently treats patients with the condition. 

“Sciatica refers to pain down the leg along the course of the sciatic nerve, and typically the cause is compression of one of the nerves in the spine,” says Mr Michael Mokawem, a consultant spinal surgeon with Cleveland Clinic London. Often this is caused by a spinal disc protrusion. “This is a disc that bulges or protrudes, squashing one of the nerves,” he explains.

The sciatic nerve runs from the spinal cord in the lower back and extends through the buttock area to send nerve endings down the leg, and sciatica, which is usually felt down one side of the body, is a common condition affecting 40 per cent of the UK population at some point. And while most patients with acute sciatica make a good recovery, 20-30 per cent have persisting problems after one or two years. 

Jump to:

• Causes of sciatica 
• What can trigger sciatica? 
• At what age is sciatica most common?
• Sciatica during pregnancy
• Effects of sciatica on sleep quality
• Best sleeping positions for sciatica pain
• Other tips for improving sleep quality with sciatica

Causes of sciatica   

• Herniated disk
• Lumbar stenosis
• Tumours (rarely)

In about 90 per cent of cases sciatica is caused by a herniated disc with nerve root compression. Lumbar stenosis – narrowing of the area of the spine that contains the nerves or spinal cord, which can lead to irritation, or compression of the nerves – is another cause. Less frequently, tumours are a possible source.

“Sciatica often has a natural pattern lasting up to two months, assuming that the nerve isn’t too compressed, however across this time the symptoms often diminish significantly, as the swelling and thereby the pressure reduces,” says Spencer. “The impact on sleep can be profound in the early days or weeks and then often improves.”

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What can trigger sciatica? 

“Often getting sciatica is just random. But there may be a genetic element to it. And some patients will say they were doing something specific, lifting something heavy, maybe twisting in an awkward manner, and it just happened as a result,” says Mokawem. A study in Norway found that occupations that involve lifting heavy objects and sedentary work, involving the handling of fairly heavy objects, are at higher risk of being hospitalised for sciatica.

“Some patients will need extra support and that might be with injections of local anaesthetic and corticosteroids to tide them over and accelerate the healing. A small number of patients will end up having an operation called a diskectomy to remove a bone fragment that’s compressing the nerve,” says Mokawem.

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At what age is sciatica most common?

While the peak age for sciatica is 45-64 years, it’s also common in the 25-45 age group. “This is partly because young adults tend to be more active but also due to their disc material,” says Mokawem. Disc material has more volume and is softer in young adults, so an injury of the disc is more likely to bulge at that point. 

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Sciatica during pregnancy

Sciatica is incredibly common during pregnancy, with the additional weight putting pressure on unstable joints and muscles, while fluid retention adds to the extraordinary strain on the body. “The patient gets heavier fast, and this very fact can promote problems with their lumbar spine and particularly with the sciatic nerve, while hormonal changes make the joints and connective tissue become loose. All of this plus the pressure from the uterus and baby’s head on the sciatic nerve puts it under strain,” says James Britton, an osteopath who specialises in treating patients with sciatica during pregnancy.

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Effects of sciatica on sleep quality

Getting to sleep – and staying asleep – can be a problem when the pain of sciatica is acute. Some people find it almost impossible to get a good night’s rest, leading to a cycle of discomfort and fatigue. Lying still is, in fact, a factor in the build-up of discomfort, allowing a build-up of inflammation and fluid, meaning pressure on the sciatic nerve. 

“Fluid accumulation tends to progress through the course of the night. This is why sciatic pain is so bad first thing in the morning but once you start to move, things start to improve because you’re moving the fluid that’s accumulated locally away from the source of the pain,” says Britton.

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Best sleeping positions for sciatica pain

On your side with a pillow between your knees

Spencer says: “It is often best to lie on the side with the painful, congested side up, in as ‘neutral’ a position as possible, using pillows to rest the top leg on and help keep the spine and pelvis untwisted.” A bolster or the long “sausage” pillows that are designed to be used to aid sleep in pregnancy work well for this. 

Sleeping on your back with a pillow under your knees

“Many patients will say it’s enough to lie on their back and put a pillow under their legs for them to be comfortable enough to sleep. Sometimes flexing the knee and hip will make us feel more comfortable as opposed to having a leg straight,” says Mokawem. Spencer says: “This position helps keep the lumbar curve neutral and unstressed.”

The foetal position

“Some people might find that bending forwards, flexing the spine and curling your knees up almost into a foetal position can be more comfortable,” says Mokawem. 

Elevated reclined position

A bent-forward position helps open up the narrowed spaces in the space, so sleeping in a reclining chair with the head elevated can work for some people.

On your stomach with back arched

For a few people sleeping on their front, which forces the back to arch, gives relief from the pain of sciatica. 

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Other tips for improving sleep quality with sciatica

Physiotherapy

Physiotherapy interventions such as exercise and manual therapy are recommended in clinical guidelines for people with sciatica. A massage belt or TENS (transcutaneous electrical nerve stimulation) machine can also be helpful.

Osteopathic treatment

“Manual osteopathic treatment can be directed to improve the health of the injured area and promote, for instance, fluid exchange around the injured area. This is essential to the body’s healing process which is disrupted by the congestion produced by injured tissue and the inflammation that kick-starts the healing process,” says Spencer. Chiropractors can also help relieve sciatica pain.

Hot and cold compresses

Spencer says: “The use of hot and cold compresses can be useful in promoting vascular flow across the injured area which clears waste and draws in fresh, ‘clean’ blood to assist with the repair.” 

A supportive mattress

Having the right kind of support while sleeping can really make a difference, says Spencer. “An aged, collapsed mattress is very unhelpful, but, contrary to the received wisdom of the past, lying on very hard surfaces is also often not ideal, unless the person is excessively heavy. A supportive but forgiving surface is ideal for most bodies.”

Moving in one unit

“Turning over in bed can be most comfortably achieved by moving the body as one unit,” says Spencer, as opposed to adopting a more cautious, incremental approach which inadvertently twists the spine. “Extending the arm (the lower one if you are turning from your side, or the one that will be upper if on your back) and sending it over with the pelvis in hot pursuit helps keep the spine aligned and avoids additional strain to the injured area.”

Gentle exercise

Once any initial intense pain has eased, gentle movement is very beneficial. “Try walking in the park on soft, uneven surfaces in preference to hard, flat ones,” says Spencer. “Pool-based therapy is very beneficial, as movement can be applied while the water supports the body weight, and reduces loading on the injured area. Initially just walking in a swimming pool can be very relieving.”

Acupuncture

Acupuncture is widely used for pain relief, and while it is still the subject of research, some has shown it is a promising alternative treatment to painkillers and other drugs for sciatica.

Painkillers

Sleep is a very important part of the repair and healing process. “If sleep is being greatly disrupted by excessive pain, especially in the early days of a sciatic episode, it is arguable that the benefits of getting sleep outweigh the downsides of a moderate and time-limited intake of pain medication,” says Spencer. 

“Whilst pain plays an important warning function, unregulated pain creates all sorts of additional problems and can feed into more long-lasting ‘chronic’ patterns. If the sufferer wishes to avoid taking pain-killers, then a topical cool gel can help, as can taking arnica before bed.”

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Illustrations by Liam Tooher

https://www.telegraph.co.uk/health-fitness/wellbeing/sleep/how-to-sleep-with-sciatica/

Doctor says one mineral 'reverses' nerve damage and sciatica pain

From getsurrey.co.uk/news

Dr Eric Berg DC recommends speaking to your GP about the possibility of a copper deficiency being the cause of your nerve pain

A doctor has explained how people suffering from nerve damage could 'reverse' the problem with one mineral he says "no one talks about". Dr Eric Berg DC claims the mineral is associated with a common deficiency behind many nerve issues.

Dr Berg, age 59, is a chiropractor specialising in healthy ketosis and intermittent fasting. He is the author of the best-selling book The Healthy Keto Plan, and is the Director of Dr Berg Nutritionals. He no longer practices but focuses on health education through social media.

In a new video for his 13 million YouTube subscribers, he says people with sciatica pain should speak to their GP about possibly upping their intake of copper. Sciatica pain refers to the discomfort a damaged nerve along the sciatic nerve can cause, which extends from the buttocks down through each leg.

The condition typically occurs from a herniated disc or when bone overgrowth puts pressure on the nerve roots in the lumbar spine. Dr Berg says: "The sciatic nerve is the longest and largest nerve in the body, and 90% of sciatica cases involve the discs in your spine."

He adds: "Sciatica typically stems from a disc problem. Copper deficiency is at the root of many disc problems, so it can be an excellent solution for sciatica. A copper supplement or copper cream can help reduce sciatica pain."

Copper is essential in maintaining nerve health and function; a lack of copper can damage nerves. Sciatica may also occur when the sciatic nerve is compressed, causing pain that radiates down the leg.

The expert explained how copper could be linked to nerve pain, telling viewers: "One of the enzymes that greatly impacts sciatica is the same enzyme that uses copper as an essential cofactor for building collagen. 75% of the outer part of the discs in your spine are made out of collagen. Copper is also used in enzymes involving your nerves and is essential for many other bodily functions."

Dr Berg says that copper is used topically in many natural therapies for inflammation and pain. He added: "It’s also used for myeloneuropathy, which can lead to various nerve problems. In many cases, myeloneuropathy is caused by a copper deficiency. Copper is very low-risk, non-toxic, and relatively inexpensive."

Although copper is a vital mineral supporting nerve function, research connecting copper supplementation to relief from sciatica is quite limited. More effective treatments for sciatica typically involve physical therapy, stretching exercises, medications, and, in certain situations, surgical intervention.

Top causes of copper deficiency:

• A lack of copper in the diet
• Intense physical exercise (especially at higher altitudes)
• Taking a lot of zinc, iron, potassium, or niacin without also taking copper
• Consuming enriched flour products
• Consuming fluoride from tap water
• Taking high amounts of ascorbic acid
• Excessive sweating
• Sun tanning too often
• Stress, high levels of DHEA, or high levels of cortisol
• Consuming distilled water
• Gastric bypass surgery
• Consuming too much sugar, coffee, alcohol, or aspartame

Dr Berg says: "A genetic problem with copper absorption can also lead to a deficiency in copper. A copper brace that wraps around the buttocks where the sciatic nerve is or other topical copper remedies may be beneficial for sciatic nerve pain."

Ensuring you’re getting enough copper from your diet is also essential. Foods high in copper include liver, oysters, shellfish, dark chocolate (sugar-free), cashews and meat. If you have been diagnosed with a copper deficiency by a GP, you may also want to consider taking a copper supplement if your health care professional recommends it.

If you think you might be lacking in copper, it's a good idea to see a doctor for testing and to talk about suitable treatment options. While copper bracelets are frequently promoted for alleviating pain, research indicates they are no more effective than a placebo.

Can any other deficiencies cause nerve pain?

Dr Berg says a vitamin B6 deficiency could cause carpal tunnel syndrome. "Along with increasing vitamin B6, you also need more vitamin B12 to support the myelin sheaths of your nerves," he said.

Sciatica is a condition caused by nerve compression

In an interesting discussion about how viruses can hide in the ganglia, which is a nerve cell cluster, Dr Berg said: "This can turn off autophagy - a state in which the body recycles damaged proteins. Here, the viruses can lie dormant until stress levels rise, which increases cortisol and weakens the immune system. Emotional stress can significantly weaken the immune system.

"This is why many dormant viruses come out of remission after a stressful event, such as losing a loved one. The herpes and shingles viruses are often seen after a significant stressor.

"These viruses need the amino acid arginine to survive. Lysine can block arginine and stop the reproduction of these viruses. You need at least 1000 to 3000 mg of lysine to block arginine."

The doctor also claimed that many people with diabetes develop a condition called peripheral neuropathy that causes numbness in the toes and feet. "Vitamin B1 in the form of benfotiamine can penetrate the myelin sheath and help reverse nerve damage caused by high blood sugar," he said. "For vitamin B1 to work, you need the cofactor magnesium."

https://www.getsurrey.co.uk/news/health/doctor-says-one-mineral-reverses-31244193

 

Antidepressants show little to no benefit for low back pain and sciatica

From australianpharmacist.com.au

Around 4 million Australians (16% of the population) are living with back problems, with about 4 out of 5 people experiencing low back pain at some point in their lives.

Antidepressants are widely prescribed for low back pain and sciatica, with up to one in seven Australians with low back pain dispensed an antidepressant – most commonly the tricyclic antidepressant amitriptyline.

However, there is inconsistency across international clinical guidelines around their use for this indication, said Michael Ferraro, lead author of a review into Antidepressants for low back pain and spine‐related leg pain and Doctoral candidate at the Centre for Pain IMPACT, NeuRA, and the School of Health Sciences UNSW.

‘The general thought was that they might be useful in some patients,’ he said. ‘At an individual prescriber level, clinicians are more likely to prescribe an antidepressant as a second-line treatment, particularly where there might be issues with sleep or mood.’

The review looked at the effects of any antidepressant class  – including serotonin–norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants – on low back pain or spine-related leg pain (encompassing full nerve compression or referred pain into the leg). 

While not all patients with low back pain have spine-related leg pain, those who do generally have worse pain and poorer long-term outcomes, Mr Ferraro said.

‘These medicines are very widely used clinically for sciatica, but there’s barely any trial evidence to inform their use,’ he said.

One class of antidepressant is beneficial for low back pain

The main outcomes of the review were impacts on patient-reported pain intensity, adverse events and function 3 months after initiation of treatment – enough time for the medicine to have a therapeutic effect.

The review is an update of an older Cochrane review, published in 2008, with the newer review incorporating results from industry-sponsored trials that tested the SNRI duloxetine. 

‘Those trials, which were run across multiple international sites and recruited large patient populations, focused on low back pain patients,’ Mr Ferraro said. 

While the review found that only SNRIs were effective over placebo for low back pain intensity, this effect was marginal.

‘When we think about the average effect in the patients that received an SNRI versus those who received the placebo, there was only a difference of around five points out of 100,’ he said.

‘That’s what we would consider small, and it might even be so small that it’s not really a benefit that your average patient would appreciate.’

Another antidepressant helps for disability

While the evidence is uncertain on the impact of SSRIs for low back pain or spine-related pain, tricyclic antidepressants were found to have no effect on pain.

However, there was one unexpected benefit unearthed.

‘They had a small effect on disability,’ Mr Ferraro said. ‘Normally we would expect any effects on disability to be mediated via pain, so that was a little surprising.’

But to demonstrate clinical benefit, there should be evidence of effects on both pain and disability, he said.

Antidepressants probably do more harm than good in back pain

The review found a lack of evidence to determine whether use of SSRIs and tricyclic antidepressants for low back pain and spine-related leg pain lead to adverse events.

However, there was an increased risk of experiencing any adverse event when using SNRIs.

‘While we didn’t look at adverse events formally, nausea, dry mouth and dizziness  –  the typical effects you’d have with an antidepressant – would be the ones that are most likely,’ Mr Ferraro said.

The next step for the research team is further investigation into the effects of SNRIs for spine-related leg pain.

‘Members of the author team are about to commence recruitment for a randomised trial of duloxetine for spine-related leg pain or sciatica, Mr Ferraro said. ‘That will be a critical study, as it will be large enough to fill the evidence gap we identified.’

Should antidepressants still be prescribed for this indication?

Cessation of antidepressants, including tapering too quickly, can come with withdrawal effects. So should patients be initiated on a treatment that could have little or no benefit, with the potential for adverse events down the line?

‘None of the trials we included in the review actually assessed adverse events after the treatment had ceased, so that’s a really key research item that must be addressed in the future,’ Mr Ferraro said.

However, when prescribing or dispensing antidepressants for low back pain or sciatica, it’s important to point patients to evidence that the benefits, on average, are small and may not be appreciable.

‘[Pharmacists and GPs] should explain that there’s a risk of side effects – and extrapolating from other data sources – that some of those effects may be related to tapering an antidepressant if it’s not effective.’

Pharmacists are also advised to check in with patients to see how they are coping with their pain.

‘The evidence we included found a benefit [of SNRIs] within 14 weeks, after a course of 2–3 months,’ he said. ‘So if there’s no benefit within the first 3 months, it would be critical to have a discussion with the pharmacist and then the GP.’

What are the alternative treatment options?

In terms of pharmacological treatments, the Australian Commission on Safety and Quality in Health Care’s Low Back Pain Clinical Care Standard recommends non-steroidal anti-inflammatory drugs (NSAIDs) for patients with low back pain who are at low risk of NSAID-related harm.

Along with antidepressants, anticonvulsants and benzodiazepines should generally be avoided – with the risks outweighing the benefits and little evidence for their effectiveness. Opioid analgesics should only be considered in carefully selected patients, using the lowest effective dose for the shortest possible duration.

Overall, medicines should be used judiciously, with physical and psychological interventions recommended first line to improve function.

https://www.australianpharmacist.com.au/antidepressants-show-little-to-no-benefit-for-low-back-pain-and-sciatica/ 

"Sciatica was destroying my life until I started using cannabis" (UK)

From telegraph.co.uk

Retired GP Franni, 68, spent decades suffering from chronic pain and tried everything from yoga to surgery. Then she found medical cannabis 

Chronic pain is corrosive. It made my life almost unbearable. My sciatica (caused when the sciatic nerve, which runs from the lower back to the feet, is compressed) meant I endured severe constant pain down my buttock and leg. Gradually it got so bad, it was agony to sit for periods of time, which as a GP is a big problem.

I tried a standing desk for years, which was exhausting, and if I ever did home visits, I’d often end up talking to my patients at their front door because I couldn’t manage any steps. Eventually, at 59, I was forced to take early retirement.

It was hard to look forward to doing anything. Nothing seemed fun. My wife would suggest going out to dinner, but I’d be reluctant because I knew I’d spend the evening in pain. Sitting on a train or plane was awful, going to the cinema or theatre was also out of the question. The pain was all-consuming, and it made me dismal. That was hard for my wife. Even though she is incredibly supportive, it’s no fun being married to someone who says no to every proposed social event.

Over the years I’ve had all kinds of interventions: steroid injections, endless pain killers, physio… I’ve tried massage, acupuncture, yoga, Pilates. When I was 50, I had major surgery on my spine. Unfortunately, it didn’t work, plus it meant I was off work for a year, which was terrifying as I had no income. That made me feel frantic.

After my operation, the specialist had prescribed tramadol, a very powerful opiate, for the pain. Almost immediately I started hallucinating. Words were coming out of people’s mouths as blue ribbons and the hospital room had turned into a jigsaw puzzle. It’s also a tachyphylaxis drug, which means it is addictive – you take one tablet, then three weeks later you need two, then six weeks later you’re up to four. I was still in pain after the surgery so I went to the GP who suggested I go back on tramadol, but I refused to through that again.

By this point I was in a bad way. Then a friend came to visit me and suggested I try cannabis for pain relief. At that stage I was open to anything that might help. So, I smoked a joint, and found the pain didn’t actually go away but it seemed to move somewhere else, if that makes sense. It was more bearable, and I was able to get off the sofa and walk around quite comfortably.

Because the cannabis was so helpful, and the side effects were negligible – I felt slightly hungrier and a teensy bit woozy, like you might feel after a couple of glasses of wine – I was interested in trying it again. But we all know how problematic it is to get hold of the stuff. Not only is it illegal, there is a dark and dangerous culture around street cannabis. So I started doing some research, and discovered Alternaleaf, one of the UK’s largest medicinal cannabis clinics (medical cannabis was legalised for certain conditions in the UK in November 2018). I reached out to them, and I haven’t looked back.

The clinic adheres to strict UK regulations, and so I was given a thorough assessment with a registered GMC (General Medical Council) clinician and consultant in pain medicine. To gauge my suitability, I had to demonstrate that I suffered from a diagnosed chronic condition, and that at least two other conventional treatments had not previously worked.

We talked for almost two hours – where else would you get that attention? – and a personalised plan was compiled with a tailored prescription for my needs. Even though the clinic is private, the costs are extremely reasonable. Consultations start at £39. Then every three months, my situation is reviewed and, if I have questions or concerns in between, there is an opportunity for them to be addressed.

It is possible to get medical cannabis on the NHS but only for certain conditions such as severe epilepsy, not chronic pain, and an extremely low number of patients have received it since it was legalised. Very few people are aware this is even an option; I feel passionately that there should be more access to this treatment.

As a person trained in orthodox medicine, others might think my choices are strange. But the standard system hasn’t worked for me and so I’ve been forced to seek help elsewhere.

I’m also regularly asked if I am permanently stoned. The answer is no. The aim is not to get high, but to treat the condition. Another typical concern is around the so-called addictive side of cannabis. The majority of addicts on the street are addicted to opiates, drugs that are often prescribed to patients. Opiates work by sticking to the receptors in our brains and nervous system; that’s how they block pain. Tolerance can build rapidly and so you need more and more.

                        Franni (pictured with her wife) now feels well enough to volunteer and travel

Medical cannabis has many different strains and specialist doctors can prescribe patients, depending on their condition. There is little evidence to suggest that medical cannabis is physically addictive. It is always prescribed under specialist clinical supervision and while psychological addiction is possible, as it is with anything linked to oxytocin (like food, social media or sex), risks are mitigated by using controlled amounts of cannabinoids like CBD and THC under medical supervision.

I’d say to anyone who is in chronic pain, give medical cannabis a go. You know how debilitating continual pain can be; it destroys lives. Of all the options I’ve been given, this seems like the one with the least negative side effects. I will admit, there are times when my short-term memory goes, but it soon comes back and, at 68, I’m pretty sharp for my age. I learnt Japanese on Duolingo last year. That was great fun.

Generally, I’ll vape my medication, or sometimes I use edibles. If I have a busy day, I’ll microdose so my head is completely clear, but the pain is parked elsewhere. Recently, I’ve been volunteering at a local garden, doing manual work. That would have been unimaginable a few years ago.

Back when I was considering retirement, the future felt bleak; stretched out before me, always in pain and miserable. I often wondered if there was any point in enduring it all? But now my world has changed immensely. I’ve been to Japan, Costa Rica, and Crete just recently; I help out at a sheep farm which opens to the public for lambing. At a time in my life when my existence could have gotten smaller and smaller, medical cannabis has opened everything up for me.

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What is medical cannabis?

Medical cannabis is a medicine which contains natural chemicals called cannabinoids, such as THC and CBD. It is used and produced to treat a medical condition and is legal with a prescription, explains Dr Laura Carro Santos, a lecturer at the UCL School of Pharmacy. It is produced under strict guidelines and differs from recreational cannabis which is a Class B drug and illegal in the UK.

What does it actually do?

Medical cannabis interacts with the body’s endocannabinoid system which helps regulate functions like pain, mood, appetite and immunity.

Many of its constituents are known to have anti-inflammatory effects “impacting on different ‘targets’ in our body,” explains Michael Heinrich, a professor of ethnopharmacology and pharmacognosy at UCL. It can treat conditions like chemotherapy-induced vomiting and nausea, muscle stiffness and spasms caused by multiple sclerosis, and rare and severe forms of epilepsy, Dr Carro Santos adds.

Is it legal in the UK?

Yes, medicinal cannabis is legal in the UK. “When there is a clinical need, patients will be able to get a prescription and access appropriate cannabis-based medicines or products,” Dr Carro Santos says.

However it is only available through a prescription from specialist doctors on the General Medical Council’s register and is generally reserved for people with severe conditions that have not responded to other treatments.

Benefits of medical cannabis

“Cannabis regulated as a medicine can generally be considered to be of good quality and safe if used based on the prescription,” Prof Heinrich says.

“It has shown benefits in treating rare forms of epilepsy like Lennox-Gastaut and Dravet syndromes, easing chronic pain and helping with muscle spasticity from multiple sclerosis [MS],” adds Prof Amira Guirguis, the chair of the Royal Pharmaceutical Society’s Science and Research Committee.

“It can also support palliative care, including reducing nausea and improving sleep for cancer patients.”

Potential risks and side effects

There is an increased risk of mental health problems such as psychosis, especially in young people and those with a family history of mental illness, Prof Guirguis says. “It can worsen outcomes for individuals with psychotic disorders, as well as depression, mania and memory issues,” she adds.

Those with a history of mental health disorders should consult a specialist doctor before use.

Other possible side effects include dizziness, sedation, visual impairment, dry mouth, and slow reaction times which can increase the risk of accidents.

How much should be used to cope with chronic pain?

“Doses for chronic pain depend on the individual, type of product, and method of use,” Professor Guirguis explains.

Inhaled products work faster but do not last as long, while oral oils take longer to kick in but provide more sustained relief.

“Any treatment plans should be tailored to the patient by a specialist, considering the method of use, desired effects and any potential interactions with other medications,” she concludes.

https://www.telegraph.co.uk/health-fitness/conditions/bones-joints/sciatica-medical-cannabis/