Medication For Sciatica

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61 Comments

  • Margaret

    Reply Reply August 18, 2011

    Thought I had stumbled on a real gem here for curing my sciatica. The first 2 videos were great, but it seems that to have any further information, we need to suscribe to a Member’s Area. So, it looks as if it is back to the drawing board again.

    • Dr. George Best

      Reply Reply August 18, 2011

      Margaret,

      There’s several videos plus a free ebook available in the free section of the site, and many people tell me that they’ve had more benefit from just the free resources on my website than they’ve received from numerous doctors and health care providers.

      The members area is an optional added resource for those who need it, and the money generated from the memberships I sell supports my time and financial investment to keep the site running.

      Dr. Best

      • Lilia

        Reply Reply September 11, 2017

        Hi doctor,
        First I would like to thank you for your information you shared with us, my daughter 16 years old had a back pain and the doctor asked for a MRI and this is the result: she has a L4-L5 disc level theres a minimal 2mm disc bulge and at the L5-S1 level is a 4 to 5mm broad posterior causing impingement to the traversing right SI nerve root and mild compression of the right aspect to the theca sac. After she got a medication she was good for two years. But two weeks ago she’s having a pain in her hip and here left leg, we went to another doctor and he said she has a flat foot in her left leg and that cause this pain I he gave her another kind of medicine and to wear a good shoes, but the pain is still going. Please doctor if you can help me please.
        Lilia

        • Dr. George Best

          Reply Reply September 11, 2017

          Disc protrusions can cause symptoms either directly (the disc directly puts pressure against the nerve), indirectly (the disc triggers inflammatory swelling which causes pressure on the nerve), or by some combination of direct and indirect pressure. Medication only addresses the indirect effects and while alleviating inflammatory swelling may eliminate pain for extended periods of time, it does nothing to help the actual disc protrusion. When the disc protrusion itself is left unaddressed, the problem will often increase over time and symptoms may return. When the symptoms do return, they may be more due to direct pressure on the nerve from the disc than from inflammattory swelling and therefore the medication that worked on a previous episode tends to be less effective with subsequent episodes.

          Regarding the flat foot, while arch instability does create added mechanical stress on the lower spine and provoke symptoms from an existing disc protrusion, it is probably not the sole problem. Correcting the arch is probably beneficial regardless, but it may or may not really help the symptoms if the disc issue is not directly addressed. Besides just wearing good shoes, some basic arch supports might be helpful.

          As with any disc protrusion, my suggestion is to begin with the self-treatment methods in my free ebook (available from the download link on the right side of this page if you have not already downloaded it). The majority of people get substantial improvement within 1 to 2 weeks with the methods in the free ebook. There are additional treatment methods in my paid members area (for information, visit this page.) If things are not improving within 2 weeks, I would suggest talking to her doctor about trying a regimen of physical therapy and/or chiropractic treatment (resolving skeletal misalignment/dysfunction is often helpful in such cases). If she’s still not improving, a surgical consult might be needed, although I don’t think it will be based on what you said the MRI showed). If surgery does need to be considered, I’d suggest consulting with a doctor who does “minimally invasive” procedures if possible, as these tend to have much faster recovery with fewer complications in my experience. Again, I don’t think surgery will be necessary.

          Assuming things go well with the self-treatment methods, it is strongly recommended that she continue using the exercises on a daily basis for prevention (as is discussed in more detail in the ebook). Discs don’t really return to a completely normal state after a protrusion and most people continue to engage in the activities that produced the disc herniation in the first place, so takine preventive steps to avoid a recurrence is advised.

          Good luck!

          Dr. Best

          • Lilia

            September 13, 2017

            Thank you for your advsie . The pain is in her left leg while the the MRI showed that she has a L4-L5 disc level theres a minimal 2mm disc bulge and at the L5-S1 level is a 4 to 5mm broad posterior causing impingement to the traversing right SI nerve root and mild compression of the right aspect to the theca sac. So I don’t understand why she has the pain in her left leg. Another question please she can’t stretch her leg when she’s sitting on a chair? Dose she needs another MRI? And does she need a physical therapy?
            Thanks in advance
            Lilia

          • Dr. George Best

            September 13, 2017

            There’s a couple of possible scenarios. First, it’s not unheard of for left and right to get mixed up on imaging reports, so it’s possible that it actually shows impingement on the left instead of the right. In addition, with broad protrusions, there can be compression/irritation of the nerves on both sides and inflammatory swelling can be worse on the side opposite where the disc protrusion looks worse. Some broad disc protrusions can also shift somewhat from one side to the other depending on positions and activities.

            Not being able to straighten the leg when sitting is a sign of tension on the nerve and is a common finding with disc protrusions and other space-occupying lesions (such as spinal cysts). In other words, it further confirms that her symptoms are probably due to the disc protrusion and/or associated inflammatory swelling.

            At this point, I don’t think a new MRI is necessarily warranted. Physical therapy and/or chiropractic would probably be worth checking into and in the meantime use the self-treatment methods until she can get scheduled to be treated. If she does not respond well to conservative treatment, I would recommend a new MRI (or at least have the first MRI checked for the left-right discrepancy to see if that was a mistake) so that any surgical consult she might have can be done with the most up to date information.

            I hope this is helpful for you.

            Good luck!

            Dr. Best

          • Lilia

            September 14, 2017

            Hi Dr.
            I have registered in your website but I tried to login the asked conPlease Enter Your Login To Access The Member’s Area. This message was shown
            Sorry, either you have entered an invalid username/password, or you may not have activated your account yet. I don’t know how I can activate my account.

          • Dr. George Best

            September 14, 2017

            Your account was activated and I was able to login using your email and password. It’s possible that there was a delay in the automated activation for some reason, but everything seems to be working now. Be aware that the password is case-specific, and is all lower-case. Sometimes out of habit people will capitalize the first letter and that will prevent the password from working. If you have any further problems accessing the member’s area, let me know.

            Dr. Best

    • peter sivillo

      Reply Reply November 15, 2017

      What is your opinion of Spinal cord Stimulators?

      • Dr. George Best

        Reply Reply November 15, 2017

        While they can be effective for pain control, by themselves they do not address the underlying causes of sciatica and other symptoms which could therefore progress to causing motor neurological impairments (muscle weakness and incoordination, loss of bowel/bladder control,etc..) In addition, 30-40% of patients with them experience issues with displacement or breakage of the implanted electrodes at some point, which necessitates further surgical intervention and the inherent risks and expense of it. For these reasons, spinal cord stimulators are generally considered a last-resort pain control intervention which would only be used after other treatment options are exhausted.

        Dr. Best

  • Donna

    Reply Reply September 16, 2011

    Hi, Could you please tell me with sciatica, does numbness of the toes go along with it?

    • Dr. George Best

      Reply Reply September 17, 2011

      Yes, the symptoms of sciatica can include numbness in the toes. Of course, having sciatica does not eliminate other possible causes for the numbness. So, if the sciatica pain goes away, but the numbness in the toes remains, it would be important to have that checked into.

      Dr. Best

      • Lilia

        Reply Reply September 14, 2017

        Hi Dr.
        Thanks for replying my email, yes I still have a problem with my account it’s not activated yet, what to do please.
        Thanks
        Lilia

        • Dr. George Best

          Reply Reply September 14, 2017

          I just checked again and your membership is activated and your login is working properly, so let’s walk through this step by step:
          Go to http://www.sciaticatreatmentathome.com/members-login/
          Enter your email, liliam@hebron.edu and the password sciatica .
          Click the login button and that should take you to the member’s area.

          Just a reminder, the password is all lowercase, so if you capitalize any part of the word it won’t work. Also, because the password is hidden when you type it in, it’s possible you’re making a typo or misspelling it. Just to be sure you have everything right, you might want to copy and paste your email and password above into the form.

          Let me know if you still can’t get it to work and I’ll try to figure something else out.

          Dr. Best

  • loga

    Reply Reply November 9, 2011

    Dear Dr Best

    Thank you for your advsie . I have had an MRI and the reult was Spinal Stenosis and disc degeneration at L4/5 and Sciatica.The neuro surgeon has recommended surgery.Please can you advise and are you suggesting my solution is excercises as suggested in your advanced treatment.Thank you for your help

    kind regards
    loga

    • Dr. George Best

      Reply Reply November 9, 2011

      Hello Loga,

      I don’t really have enough specifics to be able to predict whether exercises will help you or not.

      Spinal stenosis refers to the narrowing of the canal that the spinal cord passes through. Several things can cause this narrowing, but the most common causes are bulging discs and arthritis-related bone overgrowth. The severity of spinal stenosis can range from mild to severe.

      Depending on the cause and severity of the stenosis, exercises will vary in effectiveness. For example, stenosis that is primarily from disc bulging typically responds much better to exercises than stenosis from bone overgrowth. The more severe the stenosis, the less likely it will respond to exercises. So, the worst case scenario is moderate to severe stenosis from bone overgrowth and that typically requires surgery.

      Dr. Best

  • Amritlal Suthar

    Reply Reply November 21, 2011

    Dear Dr. George Best,
    I am from India. I am suffering from sciatica for the past two years. The pain (mild) continues at the back side of left leg starting from hip joint up to the last finger ( with numbness). I am hopeful,the Sciatica Exercises and other useful information being provided will definitely help me in long run. I convey my heart felt regards for invaluable services being rendered by you for the well- being of people suffering from Sciatica. Thanks.

    • Dr. George Best

      Reply Reply November 21, 2011

      You’re welcome. Hopefully the exercises will be helpful for you.

      Good luck!

      Dr. Best

  • Rama

    Reply Reply June 14, 2012

    Hi Dr Best

    I agee to the fact that your free resources are very helpful for me.

    But still I am having pain but it would go for sure.

    Thanks and regards

    Rama

  • Mark Lambert

    Reply Reply November 28, 2012

    Hi Dr. Best,

    I’d like to thank you for your free 2 self help videos.They have helped me alot.
    I’m a local delivery driver,and one day I just woke up in alot of pain.I had been having miniumal pain in my right hip for about 3 years now.And now after watchings your videos,I realize that that must be the pilformus muscle hurting.
    I ended up with pain in both calf and thighs like the worse charlie horses that would not go away very easily.It seem to get better after doing the Mackenzie strench.
    I’m on my 2 nd week off of work and hoping that I’ll be able to return on Monday.Being self employed,I do not have any medical insurance.I did start seeing a chiropractor through this process,and had a xray taken of my back,and describle my spine as a dish towel being rung out,LOL.Kind of scarry.
    As soon as I have the extra 30 dollars,I will become a paying member here.I still have quite a bit of pain in my right hip,butt area.And its hard to be on my feet for more than about 15 minutes.
    Would walking or something,help me or hurt my condition?Any additional suggestions you have would be greatly appreciated.
    Thank You again,Dr.Best
    Your the Bestest 😉
    Mark L

    • Dr. George Best

      Reply Reply November 28, 2012

      Hi Mark,

      It sounds like you may have some disc issues as well as piriformis problems, so I’d suggest doing both the McKenzie exercises and the piriformis stretch as frequently as possible and also try some cold packs on the lower back to help with any inflammatory swelling that may be present. For best results, make sure to follow the instructions in the free ebook. If you don’t already have it, you can download it from the link on the right sidebar of this page:

      http://www.sciaticaselfcare.com/basic-sciatica-exercises/

      Walking is usually helpful, but keep the time within your tolerance – it’s not good to force yourself through a lot of pain. It is better to walk for short periods that don’t significantly increase your symptoms on a frequent basis than to try to force yourself to walk longer with pain.

      If you have further questions, let me know.

      Good luck!

      Dr. Best

  • Mahasin Khan

    Reply Reply May 27, 2013

    Please discuss the role of Methyl cobalamins & Pregabalins in sciatica pain.

    • Dr. George Best

      Reply Reply May 27, 2013

      Methyl cobalamin (Also known as Vitamin B12) plays an important role in nerve repair and regeneration. For anyone at risk of deficiency (the elderly, people with a history of alcoholism, or family history), testing for B12 levels and/or for signs of pernicious anemia (B12 deficiency causes abnormalities of the the red blood cells) is advisable, particularly in the presence of neuropathies. Methyl cobalamin deficiency is rarely a direct cause of true sciatica (although the neuropathy from deficiency can produce symptoms in the legs), but it certainly can inhibit recovery. It is important to note that in many cases B12 deficiency is not a result of low intake, but rather a problem in the body’s production of “intrinsic factor” that is required for absorption. For this reason, deficiency is usually best treated by use of injectable or sublingual B12 so that it goes directly into the bloodstream.

      Pregabalins, such as the drug Lyrica, can provide symptom relief in some cases of sciatica. Bear in mind that as with any drug, pregabalins do not really heal the underlying causes of sciatica, but merely inhibit the perception of the pain. The effectiveness and severity of side effects vary dramatically from person to person.

  • Sonny

    Reply Reply September 2, 2013

    Hi Dr. Best,

    Will swimming be effective as an exercise in treating sciatica?

    • Dr. George Best

      Reply Reply September 2, 2013

      Hello Sonny,

      While it’s not really a specific treatment for sciatica, swimming may reduce symptoms somewhat by means of improving circulation. In many cases, inflammatory swelling plays a role in symptoms and low-impact activity like swimming increases circulation to “pump” away swelling thereby reducing pressure and irritation on the nerves. Swimming is also good as a general conditioning exercise to keep the trunk muscles toned which can help provide stabilization of the spine to help prevent recurrences of back pain and sciatica.

      Dr. Best

  • jeffreykoh

    Reply Reply October 31, 2013

    Dr Best Why can I get the Free ebook that you mention …which website

  • Alan

    Reply Reply April 22, 2014

    Hi,

    Thanks for all your videos. My question is do you think Tens machines are worth using?

    • Dr. George Best

      Reply Reply April 23, 2014

      Hello Alan,

      Some people get very good symptom relief with TENS units, while others don’t get much effect, at least not with the factory settings. In some cases, you can experiment with the settings and improve effectiveness. When they work, TENS units can be quite useful and eliminate or reduce pain without having a risk of significant side-effects. Just bear in mind that they only reduce symptoms temporarily and don’t really fix anything, so it’s still important to do the exercises, apply cold packs, etc. to promote actual healing.

      Dr. Best

      • Jimmie Noble

        Reply Reply July 21, 2014

        I would add that pads supplied with TENS units merely provide a massage effect, and massage is not particularly helpful for a pinched sciatic nerve. The skin provides a protective cover preventing deep stimulation with pads. Acupuncturists can get good results with TENS treatment because the needles connected to the elctrodes penetrate the skin and have much greater effect in stimulating blood flow and providing temporary pain relief.

        • Dr. George Best

          Reply Reply July 21, 2014

          Thanks for your comment, Jimmie.

          Actually, properly applied, a TENS unit does not create a massage effect (that occurs with muscle stimulators and with TENS units that are turned up too high so that they produce muscle contraction), but rather work to block pain signals from reaching the brain. It gets kind of technical, but the theory is that TENS units stimulate different nerve endings from those that carry pain information and flood the “gates” of the brain’s pain processing centers with that other information (this is known as the Gate Control Theory). Unfortunately, most TENS units are given to patients without any consideration to proper settings to produce this effect. Some get lucky with the “out of the box” settings, but without some work to get the settings right for the individual, they are usually not very effective.

          Acupuncturists not only tend to be more careful to get the settings right than the average doc prescribing TENS units, but the fact that they are using the TENS to specifically stimulate acupuncture points which can often reduce pain with almost any type of properly applied stimulation, often results in a quite effective application of TENS.

          Dr. Best

  • gary

    Reply Reply August 18, 2014

    Hi doctor best, lve been suffering with sciatica for about 3 years. And the pain is worst when I stand or lean back so the McKenzie exercise really hurts my pain is on leftbuttock and calf with foot pins and needles . what is the most likely cause! Gp no help just gives me narproxen .regards gary

    • Dr. George Best

      Reply Reply August 18, 2014

      Hello Gary,

      In most cases where extension increases symptoms, the problem is either that there is a large disc protrusion or extrusion that is too big to be “squeezed” forward by the extension, or that there is narrowing of the spinal canal from something on the back side of it (the disc is on the front side), or what is sometimes called “posterior element stenosis”. The most common things that produce posterior element stenosis are related to degenerative arthritis – bone spurs and/or thickening, thickening/buckling of the posterior ligament, and/or synovial cysts.

      You didn’t mention whether or not you’ve had any diagnostic imaging, but I’m guessing that if you have, it was only X-rays. X-rays are usually not very helpful for diagnosing these types of problems, so my first recommendation would be to have an MRI to further evaluate the situation. I’m not sure whether your symptoms have been constant or off and on for 3 years, but either way, it’s way past time for your doctor to have made an attempt to find out what’s going on. Most of the time sciatica is not a symptom of something life-threatening, but in rare instances it can be related to a spinal tumor or other serious condition that requires prompt attention. For this reason, I have to suggest that you look into finding a new GP who is more proactive.

      If you have further questions, let me know.

      Good luck!

      Dr. Best

  • Marilyn

    Reply Reply December 6, 2014

    Could a bone spur on inner side of knee cause sciatica.

    • Dr. George Best

      Reply Reply December 6, 2014

      It would be unusual, but a bone spur at the back of knee could potentially cause sciatica, but the symptoms would probably be from the knee down rather than from the hip and buttock down. I have never personally seen a case where there was sciatica due to a bone spur in the knee, but I have seen a few cases in which what’s known as a Baker’s cyst (also called a popliteal cyst) in the knee has produced sciatica (again, only from the knee down rather than the more usual from the hip and buttock down the leg).

      Dr. Best

  • Jean Paeth

    Reply Reply January 21, 2015

    Dr.Best,
    My husband has reverse sciatica, most of pain is in glut/groin area.And lower back. He also has scoliosis , but was not born with it and it is also on the oopposite side then normal. Also some degeneration. Chiropractor adjustments and massages are a God send for him. The biggest problem now is anxiety panic attacks, they are horrible. Can his condition cause these attacks?
    Thanks Jean

    • Dr. George Best

      Reply Reply January 21, 2015

      Hello,

      Just as a point of clarification, I’ve never heard anyone use the term “reverse sciatica” – there are many conditions that cause low back, glute, and/or groin pain, but unless the sciatic nerve is definitely involved, it isn’t technically sciatica. Perhaps a physician might have said something to the effect that the symptoms are sort of the reverse of sciatica, but to my knowledge there’s not a condition known as that. The symptom pattern your husband has could be due to a disc protrusion (which is also one of the most common causes of sciatica), or they could be due solely to joint dysfunction and muscle reaction and not due to a nerve impingement at all.

      In regards to your question about the anxiety/panic attacks, there is often an association between physical pain and anxiety. Of course, controlling pain would therefore be helpful in reducing anxiety, but the anxiety may need to be addressed directly. One do-it-yourself technique for anxiety and panic attacks that works very well for many people is Emotional Freedom Technique. You can learn more about it and download a free manual on how to use it at: .

      Good luck to your husband!

      Dr. Best

  • elita

    Reply Reply February 21, 2015

    Dr Best,
    My personal doctor prescribed me the APO-MELOXICAM (15mg cap) to take one capsule daily with food.
    Is this good enough to cure the excruciating pain in my lower back and will not cause any harm to my kidneys.
    I had a cat scan last week, positively my result said I got a sciatica.

    Thanks, Elita

    • Dr. George Best

      Reply Reply February 22, 2015

      Hello Elita,

      The medication you were prescribed is an non-steroidal anti-inflammatory drug (NSAID) and it may or may not help reduce your symptoms to some extent. Like all NSAIDs, there is a risk of side-effects including kidney damage and gastrointestinal bleeding, but the risk is relatively low when taken short-term. As a point of clarification, a CT scan doesn’t say that you have sciatica. Sciatica is a symptom (specifically, pain into the buttock which may extend down the back of the leg), not a disease nor structural issue you can see. A CT scan would show things like a disc protrusion or a bone spur which in turn could cause sciatica. In many cases, inflammation contributes to the symptoms produced by such structural issues, but it is not usually the primary problem. So, using an anti-inflammatory medication will usually help reduce symptoms related to the inflammation, but it does nothing to help the underlying cause. Even when such drugs provide complete relief, because the underlying problem remains, the symptoms usually will return at some point. For this reason, I strongly recommend using methods such as those in my ebook (if you haven’t already downloaded it, you may do so from the link on the right sidebar of this page: to address the actual cause, rather than just suppressing the symptoms with drugs.

      Dr. Best

  • samir

    Reply Reply June 14, 2015

    Dear Dr. Best
    My name is Samir and I am from London, UK
    Recently I have experienced a shooting paint starting from my lower back going all the way to the left leg. When the pain became unbearable, I had to go to A&E and the Dr confirmed that I had Scaitica and ordered MRI. The MRI showed that I had a scyst blocking you nerve and he suggested surgery. Do you think surgery the best option.
    Pls help

    • Dr. George Best

      Reply Reply June 14, 2015

      Hello,

      If the primary cause appears to be a cyst, chances are surgery is going to be the best treatment approach. Although spinal cysts sometimes go away over time with non-surgical treatment, this is usually not the case. The good news is that the cyst can probably be removed with a “minimally invasive” surgery. This is done through small incisions using a viewscope and most people are able to return to most activities within a week or two. Good luck!

  • annette

    Reply Reply July 22, 2015

    Hi.. i have a question – my friend & i are realky thinking about looking into ” ACCUPUNTER THERAPHY ” what is your thoughts? Please Help ☺

    • Dr. George Best

      Reply Reply July 22, 2015

      I assume you mean acupuncture, and it can be helpful for many conditions, including sciatica. No treatment is 100% effective, but acupuncture is definitely worth a try.

      Dr. Best

  • ashish

    Reply Reply September 1, 2015

    Sir my mother is having pain in lower back when she stands she has a pain on her left side of legs with tingling which is unbareable when she seats in some positions the pain goes and if she sleeps the pain totally vanishes is that scaitica

    • Dr. George Best

      Reply Reply September 1, 2015

      She probably has a disc protrusion in her lower back and the leg portion of her symptoms are probably due to sciatic nerve irritation (sciatica) caused by the disc protrusion. Since the symptoms go away when she sleeps, chances are good that she can treat the problem herself using the methods in my free ebook. If you do not already have it, you may download it from the link on the right sidebar of this page. If she does not get much improvement within a week or two, I’d recommend seeing a doctor for further evaluation.

      Good luck to her!

      Dr. Best

  • carole moller

    Reply Reply October 10, 2015

    Hi Dr Best, does age has anything to do with Sciatica
    thanks

    • Dr. George Best

      Reply Reply October 11, 2015

      Hello Carole,

      Age is not really a major factor in itself. On the one hand, older individuals tend to have more degenerative issues in the spine that can contribute to sciatica, but older individuals are less likely to sustain an acute disc protrusion (since the inner gel of the disc tends to become less fluid as we age).

      Dr. Best

  • James P.

    Reply Reply March 14, 2016

    Hey Doc,

    I recently (last 2 weeks) have had tell-tale symptoms of Sciatica out of nowhere. Pain begins in the lower back/buttock area and goes down my right leg, mostly in the upper leg, and below the knee to a lesser degree-it feels as if there is one long thick nerve cord that is hurting-aches, tingling, soreness, and cramps are all isolated to what feels like 1 major vertical nerve. The pain is less than debilitating but still highly uncomfortable. I was already taking gabapentin, NSAIDS and a mild opioid. PRN before this for unrelated reasons, and they are be helping somewhat with the pain, as it tends to come & go, but they do not ever get rid of it completely.

    My guess is that being in bed way too much lately while awake during the day, almost daily with an old, low quality mattress may be the cause of my symptoms. Could there be a correlation between long hours on my back in a sunken mattress and the cause of my pain? How about posture while in a driver’s seat of a car? Based on this pain, would there be any use in seeing a physician? I’m still experimenting with stretches that will help. Any comments on what I said would be appreciated.

    • Dr. George Best

      Reply Reply March 14, 2016

      Lying on an unsupportive mattress could have brought on the symptoms, as could prolonged sitting of any kind, including driving. Since the symptoms are intermittent, it probably can be managed with the self-treatment methods in my free ebook. Making an effort to get off the bed and move around more would also be a good idea, if possible. If things are not improving within a week or two, then it would be advisable to see a doctor to make sure there’s not some other problem.

      Good luck,

      Dr. Best

  • Jk

    Reply Reply July 25, 2016

    Hello doctor
    In the video above you said medication can not cure sciatica and exercises is just for pain relief,does this mean sciatica can’t be cure completely?

    • Dr. George Best

      Reply Reply July 26, 2016

      “Cure” is a relative term. While it is certainly possible to get rid of symptoms for an extended period of time with whatever treatment is effective for a given case, in most cases it is better to think in terms of managing the condition long-term rather than thinking of a once and for all cure. Medication is just for symptom relief, but exercises (such as the ones in my ebook) can be a good long-term management method to keep the underlying causes of the symptoms in check and most people can minimize the frequency and severity of symptom recurrences with preventive exercises, either as a stand-alone treatment regimen or in combination with other forms of conservative treatment such as chiropractic and physical therapy.

      Going back to the idea of a complete, permanent cure, in most cases that is simply not a realistic expectation, even with surgery. So again, long-term management and prevention is really the way to look at it, not going in with the expectation of a one-time permanent cure.

  • Lorraine imhoff

    Reply Reply August 7, 2016

    Hello Dr Best,
    I have sciatica so severe I have 24/7 pain. Would you recommend Tylenol 4 or oxycodone for pain relief. I can’t even sleep at night…

    • Dr. George Best

      Reply Reply August 7, 2016

      Different medications work to varying degrees for different people, so the best suggestion I can give is to try each one and use whichever seems to work best for you. Unfortunately, medication is of limited usefulness in the more severe cases of sciatica, so I recommend you work with the exercises and cold packs per the instructions in the ebook as much as possible to try to get things headed the right direction as quickly as possible. You did not mention what professional evaluation you’ve had so far. If it has not already been done and if you don’t have substantial improvement in your symptoms within one to two weeks, I would recommend looking into getting an MRI or CT scan to further evaluate the issue and help determine your best treatment options. Good luck!

      Dr. Best

  • HARRY MILLER

    Reply Reply August 11, 2016

    Do you have any thoughts on low power laser treatment for sciatica?
    Also, my pain in most severe in the buttocks and foot. Could this indicate peteformis mussle problems rather than
    back problems?

    • Dr. George Best

      Reply Reply August 11, 2016

      Laser is usually helpful for reducing inflammation and muscle spasm; however it is not likely to help much when there is a major disc protrusion or some other space-occupying lesion (such as bone spurs, degeneative ligament thickening, spinal cysts, etc.) in the spine that is directly compressing the nerve. Symptoms in the buttock and foot could be due to nerve compression in the spine, piriformis syndrome, or both. While not completely definitive, the two simple tests discussed on the homepage of this website will give some indication as to whether the problem is more due to spinal issues or the piriformis.

      Dr. Best

  • Juergen

    Reply Reply August 13, 2016

    Dear Dr. Best,

    I am very pleased to have discovered you on the web and I have found your precise information about the causes and the appropriate interventions to be very informative.

    With regards to other pain-relief measures besides the NSAIDS and steroids plus the exercises you carefully delineated for your patients, I’m wondering what you think about the TENS (Transcutaneous Electrical Nerve Stimulator) appliances that come in many price ranges usually battery operated, and which are supposed to interfere with the “wound up” pathways between the stimuli at point of origin and the brain. (I learned that the pain is really in the brain). These pathways are apparently created where the pain has lasted for longer periods (beyond 90 days) rendering that “chronic” by definition. So, from what I understand, even if the point of origin is not particularly damaging like a burn for instance which is immediately harmful, the signal is transmitted to the brain and the TENS devices would in a sense block the signal. Your take?

    • Dr. George Best

      Reply Reply August 13, 2016

      TENS units are helpful for some people, but overall I have not found them to be particularly effective for sciatica and other nerve entrapment conditions. I suspect that the pain signals with nerve entrapments are simply more intense than with other pain conditions and that they largely overwhelm the pain blocking effects of TENS. That said, different individuals will get different results, and since the potential side effects from TENS are minimal, there’s no harm in trying it if you want to do so.

      Dr. Best

  • Richard Dellorfano

    Reply Reply April 21, 2017

    i have had a spinal condition for 20 years, with off and on episodes lasting up to ten months at a time before resolving to near normal status. My last episode is still symptomatic, worse ever, with radiculopthay flashes and brief buckling paralysis of my leg on walking. Some numbness too and spasms of glutes. Bulging pressure on L4 nd L5 nerves apparently the cause.

    I just came from a diagnostic discussion with my orthopedic surgeon.”Nothing serious.” He said my spine looks great, 10x better thatn his mother’s (she and i are 75) and he wouldn’t recommend surgery for her or me. Instead, he prescirbed nerve shots, antiinflamatories and nerve medication. Same old story. So if it’s so great, why am I in constant pain? I want premanent relief, not your temporary treatments.

    I’m a retired electrical engineer. I just rebuilt my 99 Accord and it runs like new. Putting Marvel Mystery Oil into the engine didn’t cure its problems. I wanted a permanent fix, so I rebuilt it with major ‘surgery.’

    I told the doctor, I’d consider having him do his microdiscotomy and lateral faraminotopy minimal invasive surgery. Apparently, it’s the only way to get more or less a ‘fix’ of the problem, sort of like rebuilding an old car for another 100k miles,symptom=free. I don’t want to be age 85 using a wheeler to get from Pt A to B.

    Why not surgery? Reason dictates, if money is not a serous obstacle, then do it. Endless PT exercises, and precautions lifting objects, playing sports like PingPong or tennis don’t do it for me. Sciatica all takes the joy out of living.
    What am I missing here in this logical reasoning process?

    • Dr. George Best

      Reply Reply April 22, 2017

      The first question I have is what recent imaging was done that the surgeon is basing his opinion on? In long-standing cases like yours, there’s sometimes a tendency to look at old imaging studies and maybe just update with regular X-rays. X-rays are not sufficient for diagnosis in a case like yours in my opinion. An MRI (preferable unless you have some kind of metal implantation in your body which contraindicates it) or CT scan is needed to be able to evaluate the soft tissue structures as well as the bony structures. If you haven’t had an MRI or CT in the past year or two, that would be my first step.

      If you have had a recent MRI or CT, it is entirely possible that it has been mis-read by either the orthopedist, the radiologist, or both (rare, but I’ve seen it happen). The other possibility that comes to mind is that you may be in Canada, or possibly Ireland. I don’t know what the deal is in those countries, but they REALLY resist doing surgery on anyone under the NHS. I’ve seen cases with full-on disc ruptures in which the doctors outright lied (my assumption since the radiology report clearly indicated a major problem) and told the patients there was nothing wrong and just stick with the pain meds. If that’s the case with you, it is not easy to get the necessary treatment, but there are ways I can go into if need be.

      Finally, it is possible that you have had a recent MRI or CT and it did not show anything significant. In about 25% of cases, standard MRI (done lying down) failed to show significant disc lesions that did show up on upright or loaded MRI. If your symptoms are significantly better when lying down versus standing or sitting, there may be a problem that would go undetected by a lying down MRI. If that is a possibility, I would inquire about getting an upright MRI (or a loaded MRI, which is done lying down with a harness system to mimic weight bearing).

      If you’re in the U.S., you’re likely on Medicare and if the diagnostics don’t show anything significant to do surgery on, the surgery won’t be covered. You have to have a good reason for them to cover such an expense, and if the surgeon can’t justify it, he probably doesn’t want to try to get authorization from Medicare (it makes him look bad and if he does it too often, it can trigger audits and all sorts of unpleasantness for him).

      From what you’ve said, surgery is probably indicated in your case, but the diagnostics may very well be the issue. If you’ve had recent imaging, you can get a second opinion, either from a local radiologist, another surgeon, or you can send the report and/or images to me to take a look. Just an FYI to temper expectations, surgery might or might not get you symptom-free, but it sounds to me like it probably would make a significant improvement in your case.

      Hopefully this clears some things up for you and at least gives you a point to move forward from.

      In any event, I wish you good luck!

      Dr. Best

  • Richard Dellorfano

    Reply Reply April 22, 2017

    Dr Best, excellent response.

    Mine was a recent MRI, 2016, but not load-bearing. Though it shows significant protrusion and intrusion on the right L5 nerve root, the doctor may have had prior experience with Medicare that would shy him from recommending surgery. (nowadays six appeals are common).

    I emailed him about his mother, whom he said was 10x worse but wouldn’t do surgery on her either. That begs a lot of questions, among them, her overall health condition, etc. My health is fortunately excellent. I’ve even managed to redensify my spine 21% over the last 10 years, from Osteoporosis to Oteopenia, better than 90% of my age group using Strontium citrate daily 650mgs. I tried supplements expertly with no satisfaction before using strontium. Amazing stuff being used in Europe.

    \\\\ You’ve confirmed my logical response, and that maybe other factors are skewing the doctor’s decisions. He wants me to have foraminal nerve injections, which I’ll do, mainly to determine the true source of my aches and pains. Then I’ll insist on a load bearing MRI, and see what he says after that. Good advice.

    Frankly, if Medicare won’t preauthorize, I am blessed with adequate funds to finance surgery myself. However, I’d consider stem cell therapy as well to regenerate the disks, again self-financed. Not sure about the order to do this, but I’ll be counseling with Regenexx locally here in San Diego on stem cell treaments. Determined to rebuild my body like my old car. Enough’s enough.

    • Dr. George Best

      Reply Reply April 24, 2017

      Hello Richard,

      It does sound as if there are non-clinical factors that are swaying the surgeon’s opinion. Since you are on Medicare, there are going to be certain hoops to jump through before they’re likely to authorize coverage for surgery. In addition, while you have the financial resources to pay for the surgery yourself, it’s a messy situation when you are on Medicare. Because the service is one that is potentially covered under Medicare, the doctor is required to go through the Medicare procedures first and get a denial of coverage before you paying out of pocket for it is even an option.

      The stem cell therapy would not be covered by Medicare, so it greatly simplifies things with regards to paying out of pocket. The procedure is still pretty new and it’s hard to separate the marketing hype from the reality. I think the potential benefits depend largely on the specific nature of the problem. Cases with a lot of bony overgrowth contributing to the nerve compression probably are not going to get the same results as cases where the primary issue is disc protrusion and degeneration.

      Anyway, I wish you good luck whatever you wind up doing.

      Dr. Best

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