From oregonlive.com
Dr. Keith Roach is a physician at Weill Cornell Medical College and New York Presbyterian Hospital. He writes an educational column on infectious diseases, public health and sports medicine. North America Syndicate
DEAR DR. ROACH: My husband has been totally disabled by sciatic pain for three months. His doctor prescribed 4 mg of methylprednisolone, but it hasn’t done anything to eliminate the pain. He uses a cane. Are there any other things he can do to stop this debilitating pain? -- H.B.
ANSWER: The sciatic nerve is the largest nerve in the body (about the size of your finger, only a little flatter). It comes off the spinal cord from the fourth lumbar vertebra through the third sacral vertebra, and provides sensation, motor and reflex innervation to the lower leg and foot region. The term “sciatica” is often used for pain in the foot or leg thought to be due to damage or compression of the sciatic nerve. Many conditions, including disk herniation, spinal stenosis and degenerative disk disease, can cause this.
Sometimes inflammation can exacerbate a chronic issue and cause acute back pain. A powerful anti-inflammatory like methylprednisolone, which is a glucocorticoid (steroid), can reduce inflammation and help the pain. I seldom use this treatment, but it is reasonable in some cases. If it is going to work, it will work within a few days. Long-term treatment with this medication is fraught, with the potential for many side effects including high blood sugar, bone loss, high blood pressure, weight gain and psychosis.
Persistent and disabling symptoms should prompt an evaluation for the underlying cause. Three months is too long to wait. An imaging study, such as an MRI, is indicated to see what could be causing his symptoms.
If his regular doctor is not doing anything more than continuing a treatment that has not helped and has high potential for harm, it is time for another doctor. Experts in sciatica include neurologists, rheumatologists, physical medicine and rehabilitation doctors and, when appropriate, surgeons such as orthopaedic surgeons and neurosurgeons.
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