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Sciatica (Sciatic Nerve Pain) in Seniors

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What is sciatica?

Sciatica is a condition in which there is compression of the sciatic nerve causing pain and other symptoms which are experienced supplied by this nerve. It is usually present on one side of the body. The sciatic nerve and its branches supply the lower back, hips, buttocks and the legs. Therefore symptoms are usually experienced in these areas of the body. Sciatica is commonly seen in cases of degenerative disc diseases of old age and other spinal diseases. It is among one of the more common causes of one-sided lower body in seniors but often remains undiagnosed as seniors believe these pains are due to the “normal process of aging”.

Sciatica Symptoms

The main symptom in sciatica is pain that radiates from the lower back to the buttocks, back of thighs and calf. The pain can be throughout the distribution area of the sciatic nerve usually following a path from lower back to the back of legs or it can be present in isolated areas along the course. The pain can be severe or mild and usually tends to increase with activity. It could be of a sharp, burning nature or can be felt as an electric shock.

Sciatica pain can be debilitating. It tends to present with other symptoms usually isolated to one side of the body. Numbness and tingling may be present in the legs. Varying symptoms may be present when both legs are affected  such as pain and numbness in one legs and tingling in the other. Loss of sensation and weakness may also be present.

Causes and risk factors

Herniated disc (slipped disc) or bone spurs of the vertebra can cause compression of the sciatic nerve resulting in inflammation, pain and numbness on the affected side. The sciatic nerve could be damaged due to diseases like diabetes mellitus, a condition known as diabetic neuropathy. Compression of the sciatica can also be caused by various growths and tumors including cancer.

The following risk factors have been identified for sciatica :

  • Age-related degenerative disc changes can cause reduced disc height and thus compressing the sciatic nerve placing older people at more risk of developing sciatica. This is also seen with osteoporosis.
  • Obesity can cause excessive stress to the spine resulting in disc space damage and narrowing thereby causing sciatica.
  • People with occupations involving prolonged sitting or people with a sedentary life style are more likely to develop the disease.
  • Diabetics are also at risk if their diabetes is poorly managed.

Treatment

Imaging studies such as X-ray, CT scan and MRI help in the diagnosis of spine deformities. The pain of sciatic usually resolves on its own with rest in acute settings. Cold and hot packs and stretching exercises can help. If the pain does not resolve, the following medications can be used:

  • Anti-inflammatory drugs.
  • Muscle relaxants.
  • Tricyclic antidepressants.
  • Anti-seizure medication.
  • Narcotic painkillers in severe cases.

Physical therapy can be helpful. This involves exercises to help strengthen the muscles of the spine and correct posture and prevent recurrent trauma to the spine. Traction may help ease the pressure on the sciatic nerve but often the condition recurs shortly thereafter. Corticosteroid injections help reduce the inflammation though repeated injections may be needed for continued relief of pain. Surgery may be indicated in severe cases when there is severe weakness and pain and when pain does not improve with conservative treatment. Bone spurs if present can be surgically removed. Disc space narrowing can be treatment with spinal fusion or disc replacement.


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