Friday, May 15, 2009

June Blog

What is Sciatica? Sciatica is pain radiating down the back of the leg. It is frequently described as a deep tooth ache like pain and sometimes burns. It may be accompanied by numbness and tingling and leg weakness.
What Causes Sciatica? Sciatica is the result of irritation and inflammation of the sciatic nerve. There are a lot of potential problems that can cause sciatic pain: herniated disc, narrowing of the spine, osteoarthritic spurs and joint narrowing, entrapment syndromes (piriformis muscle for example), trauma, lack of proper nerve movement or stretch, cysts/tumors and mechanical joint pain.
How is it Treated? Diagnostic and examination techniques are used to isolate the problem such as x-rays, MRI. If nerve root tension signs are absent, the cause is likely outside the spine.
a. Medical Treatment: surgical intervention, physical therapy, medication, epidural steroids.
b. Chiropractic/Alternative Treatment: manipulation, flexion/distraction, McKenzie exercises, nerve mobilization, physical therapy modalities (electrical pain control, stretching, exercises. deep tissue therapy). Surgical referral for non-responsive cases may be necessary.
Prognosis: guarded. Many people progress to totally pain free in a short time and others may end up with intermittent or permanent residuals.
Caution is always necessary in the case of sciatic pain if progression results in loss of bowel or bladder control, saddle anesthesia, or worsening symptoms.
Restless Leg Syndrome:
What is it? Restless leg syndrome is the sensation of needing to move the legs and may be accompanied by abnormal sensations such as prickling, tingling, crawling sensations.
What causes it? Many conditions can mimic the sensations such as arthritis, varicose veins, interittent claudication, side effects of medications, maintaining uncomfortable positions, and leg cramps. Causes may be linked to kidney failure, rheumatoid arthritis, diabetes, nerve damage, anemia, and Parkinson's disease.
How is it treated? Medically, treatment consists of medications that are dopamine agonists, anti-convulsives, sedative-hypnotics, opiods. Look for other underlying disease conditions that may mimic RLS (diabetes, anemia).
Are alternative treatments available?
  • Avoid tobacco, alcohol, and caffeine.
  • Keep your bedroom cool, quiet, and comfortable, and use it only for sleeping, not for watching TV.
  • Get regular exercise.
  • Massage the leg or the arm, or use heat or ice packs.
NSAIDs. I'm vindicated. Having had previous experience with minor use of non-steroidal anti-inflammatories (NSAIDs) in the form of aspirin and ibuprofen and my wife getting acute gastritis (with at $3,000+ bill for an ER trip) I have been harping on the risks of these medications on the stomach/GI track. The World Health Organization estimated somewhere in the neighborhood of 50% of chronic users have problems. It is my opinion that this may even be low as a lot of people don't end up going to the doctor's office and reporting stomach issues that they self medicate with antiacids or OTC medications like prilosec. The guidelines are as follows: "A recent document by the Journal of the American Geriatrics Society has come out with recommendations that anyone over 75 should not take NSAIDs. They recommended use of NSAIDs and COX-2s only "rarely" and "with extreme caution" in highly selected individuals, such as those for whom safer therapies have failed.
For most seniors, acetaminophen (Tylenol, Excedrin) should be considered as "initial and ongoing pharmacotherapy in the treatment of persistent pain, particularly musculoskeletal pain," they said. They noted that the presence of hepatic insufficiency and/or chronic alcohol use are relative contraindications.
Opioids may be safer than long-term NSAID therapy and should be considered for all patients with moderate-severe or quality-of-life-impacting pain, they added. Breakthrough pain with opioids should be anticipated and treated with short-acting, immediate-release opioids. "

In other words, its safer to take opiods than NSAIDs. Tylenol is a safer way to go if no liver or prior alcholic problems. A recent study even questioned the advisability of regular ingestion of aspirin (acetylsalicylic acid) to keep the blood thin for heart patients. The possible side effects may be worse than the symptoms aspirin is trying to control.

My recommendation: boswellic acids, fish oils. When combined with glucosamine for arthritic joints I have found this helps patients.

Internet Anonymity:

Take care on what you write and post on various internet forums. The anonymity of the internet allows people to write what they want without consequences and without burden of proof. You never know what kind of crackpot you'll run into out there.