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Taming the pain of sciatica: For most people, time heals and less is more
- By Steven J. Atlas, MD, MPH, Contributor
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Dr.Atlas, I had a few questions regarding this article and sciatica. Why is the pain associated with sciatica worsened when coughing? Is it because coughing increases pressure on the discs in the lower back like sitting? Also, I know that this article includes ways of reducing pain and managing symptoms but is it possible for the symptoms of sciatica to completely disappear without external help such as surgery or injections? Lastly, is it possible to have sciatica with chronic back pain as well? Thank you!
You’re correct – things that increase pressure in the disc space can worsen sciatica. This includes things like bending over, sitting and coughing. Regarding your question about symptoms disappearing without external help, this is a key point of my piece. Yes, for most (over 75%) symptoms improve with time. We believe this is related to inflammatory cells in the body recognizing the disc material that has migrated out of the disc itself as being out of place and working to reabsorb the material. This can take weeks, which is why sciatica typically lasts longer than usual low back pain due to muscle or soft tissue strains. Also, it isn’t clear whether injections help the body resolve the problem. Studies are conflicting on whether injections decrease the need for subsequent surgery. But it is possible that the anti-inflammatory agents used may prevent the body from healing itself as noted. Finally, it is possible to have chronic back pain with sciatica. This includes patients with chronic low back pain who then develop sciatica due to a new disc herniation or those who actually have sciatica for a long period of time. The challenging issue is that surgery appears less effective in those with chronic sciatica. Depending on the study, this refers to symptoms that have lasted more than 6 – 12 months.
I am surprised you didn’t mention stretching and/or yoga, both of which are effective in managing sciatic pain and symptoms; yoga has a specific stretch, lying on one’s back, that addresses sciatica;
Thanks for your comment. In a short piece like this, it is hard to cover everything. I do refer to physical therapy that would include stretching. These treatments can help keep one active as the body deals with the disc herniation, but there isn’t much evidence that these treatments, including yoga, decrease pain or affect the overall outcome. Most studies showing the benefit of yoga have been in those with chronic back pain without sciatica.
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