Best sciatica meds/treatment
 

Ok, so I'm here to find info about the best possible options for pain relief for sciatica/neuropathy/possibly fibromyaliga

To make a long story shorter (somewhat) , work injury left me with moderate to excruciating pain in low back down right leg, with reduced sensation in right foot.

The pain is like a very hard constant ache in my lower right back, buttock and right leg to the ankle. It seems sometimes if I stretch just right, I can take some pressure off my low back, but then the leg is worse and my foot/lower leg go numb or pins & needles. On the other hand, if I stretch out the leg, to try to relieve that pain, the back is worse; can't win.

We've tried PT for my calf with no success, I used to take Neurontin for unrelated trigeminal neuralgia and headaches before this happened, and it worked for a while then had to be doubled, then doubled again, until it made me fall asleep if I stayed still for more than 30 seconds, so I quit taking it.
For this back and leg pain, I take hydrocodone 7.5/500 3-4x daily, ultram 100mg 3-4x daily (I was taking the ultram for trigeminal neuralgia before this happened) and have tried Lyrica which made me suicidal and looking for a fight with my partner and kids, so it's been added to my 'allergy' list.

I've been interested in a TENS unit and/or ultrasound therapy, but without knowing anything about them or really how to use them, I'm scared; plus I don't know what brands, etc are the best if they do work?

I sit on heating pads 12-18 hrs a day, and have burns on my back and buttocks (and skin changes from them) because the heat is about the only thing that offers minor relief.

I'm getting nowhere with doctors and lawyers and insurance reps and physician assistants and I hoped someone here could offer the wisdom of their experiences. Please?

Well, I can share experience only. I'm still trying to find relief myself. If you check my profile you'll see my long list of "issues", none the least of which is failed back surgery that left scar tissue around my sciatic nerve (not much that can be done for that). Not being a dr. I can only tell you what it sounds like to me. It does sound like you have more going on than just the couple of things you describe. Have they given you an EMG yet? You may have nerve damage that's more difficult to treat. Something that has helped me to a degree is Cymbalta. That may or may not work for you. But it's at least worth talking to your dr. about. You may want to ask for an EMG as well if you haven't had one. And most importantly ICE. The best relief I get is when I lay on an ice pack. Granted this doesn't last long, but it sure does work well. Wish I had more words of wisdom, but don't give up. We're bound to find some releif eventually. Best of luck to all of us!:hug:

I agree with Im4dexter about the ice treatments.

My chiropractor was adamant about heat. No more than 20 minutes if you must. The heat aggravates nerves and makes it worse over time. When nerves get jazzed up they fire constantly.

I would try ice, for 20 minutes 3 times a day with a thin cloth between the ice pack and the skin. That may help and may take a few days.

Another thing that works for nerve pain for me is Lidoderm patches. Place the patch over the spine at the level where the sciatic nerve goes to the spine. (not at an endpoint in the leg anywhere). This drug penetrates in a couple of days use and is a sodium channel blocker and blocks the pain signal from going to the brain. If you are lucky like I was with my MP pain, in 2 weeks of every day use the nerve may settle down.

Even now with my MP pain in remission, heat can still activate it. It doesn't take much heat...say 10minutes in a steam room, to get it to fire painfully.

Lidoderms are expensive, but well worth it if they work for you.
Some insurances require a previous diagnosis of shingles, but others do not. So you need to check on that.

What about chiropractic or body worker therapy?
I'm thinking address the whole body, since you have a few things going on.

Most quality PT places should have a TENS, ultrasound etc..

If your injury was a hit or fall of some sort- something could be out of alignment.
If so a good chiropractor, or possibly an Osteopathic dr, or physiatrist might be of more help.
ask questions and interview them before selecting, so you aren't wasting time with uniformed care.

A TENS might be helpful - your PT should be able to set up a test or trial to see if it would and then your Dr could Rx one for you.

Ultrasound will feel good most likely if muscle pain is an issue.

My dad uses his TENs quite often now for his DDD.
TENS helps to block the pain signals.

I have a EMS {electric muscle stimulator} and my chiro uses a IF stim at his office, as well as a Low level laser {aka cold laser,soft laser}
- these all work for me for my muscle pain.

nothing to be afraid of at all - unless someone turns the stim up too high :eek:- but you can control that. usually they (PT) slowly increase the stim and ask you to let them know when to stop at that setting.

some videos links -
http://www.google.com/search?q=pain+...46717b9b9556d9


this link has quite a variety if alternative care info links - although it is from our TOS forum -the therapy info covers many ailments -
http://neurotalk.psychcentral.com/post388-1.html

If you do feel better with heat look into far infrared heating pads - penetrate deeper and no chance of burns. better for cell healing also.

Hi 72daywmn,

My wife suffers from Fibro & nerve impingement. She had been on gabapentin (Neurontin) a while back and had a similar experience to yours, but our orthopedist recommended (prescribed) she try it again on an 'as-needed' basis for flare-ups, and it's working very well for her that way. He said that since she'd been on it before without incident, the risk of any adverse effects would be minimal (and he uses it this way himself). The best(?) part is that the dose she requires is usually only 1/3 of what was initially prescribed, so it was reduced, and she's not plagued by drowsiness, etc. but she can titrate up a bit if necessary (very seldom). This is not something to try on your own; this is something to discuss with your prescribing doctor.

There's nothing to be scared about with a TENS unit - many/most run on a 9 volt transistor battery. They do, AFAIK, require a prescription, and a little orientation from a PT might be advisable/helpful. We have an Empi unit, and it's been just great.

Doc

I can reiterate, that ice is the chosen treatment for sciatica. I was told by my neurosurgeon to use it for 20 minutes every 2 hours, and it DOES help.

I've had severe sciatica for 26 years due to a couple of botched surgeries. My doctor put me on the Fentanyl patch along with Methadone, and that has WORKED to ease the pain of sciatica. It's been a miracle for me. Nothing before this has worked at ALL -- and believe me, I've tried it all thru the years!
This is supposed to be the treatment for "hard to treat patients." :rolleyes:

Perhaps if you asked your doc to try it, he would. I can only hope. I've tried the Tens Unit, I've had the Spinal Cord Stimulator implanted, and nothing worked. So like I said, this has been a miracle.

I wish you the very best. God bless. Hugs, Lee

Thanks Lee and everyone for the input...

I've been told that this is sciatica, and I can tell that it is related to a nerve because of the type of pain it is -shooting, burning, 'zapping' kinda pains on top of hard ache, with numbness and tingling in my foot, and reduced skin sensation below the knee. Sometimes I'll be able to deal with the ache, with relaxation techniques, etc, and then it will hit me like I'm being poked in the butt cheek, or anywhere on my leg with a cattle prod- a hot poking jolt of lightning kind of pain that well, (pardon me if you haven't heard the saying) but it makes me feel like I'm going to p.ss down my leg!
And on rare occasions, I have lost some degree of bladder control.

Again, with this being related to work comp, its difficult to get through red tape to do anything. This has been going on for more than 2 years now. My lawyer sends me to a dr, who says one thing, then the ins co. sends me 3-6 months later to their dr who says the opposite. So then we go to court in another 3-6 months, and the court tells the ins co that they have to pay for x, y or z, and then it takes another 3 months to get somewhere to get x, y or z.

I don't know what to do, but I thought I could get some input here because I am tired of waiting on them to figure it out, and tired of being an invalid.

If I lay on my back and lift my leg, it hurts clear down my leg before I get my foot 4 inches from the floor, and I can feel it painfully 'pop' or 'snap' in my back on the up and down motion. Sometimes I feel like if I could just stretch my back out enough then it would 'pop' back as it should be, but of course that doesn't happen. The other day I had a friend pull on my leg until my back popped, and it felt great on my back but then my whole leg went numb. So I'm terrified to try too much.
It just seems like there's got to be SOMETHING that I can do other than sit and hurt!

What I've tried, and the results:

Neurontin -started at 300mg 3x/day up-ed to 1200mg 3x/day- PMS type mood swings varying from moderate to severe, dependent upon dosage, severe lethargy/sleepiness, also related to dosage.

Lyrica- 100mg 2x day - Severe mood swings and suicidal thoughts, partner says I wasn't myself at all, as if I'd been on a 3 day bender (and I don't drink) but I remember nothing I said or did for the 5 days I took the Lyrica.

I will never take Lyrica again, and am reluctant to do Neurontin again after the sever Lyrica reaction since they are similar in nature and I did have some bad effects with it before.

Similarly, some have mentioned Cymbalta, but I don't want to take anything that affects brain chemistry in those ways - I had bad reactions to tricyclic antidepressants many years ago.

Advil, Aleve, prescription strength Naproxen, Celebrex, Mobic - no relief at all and a lot of stomach problems

Hydrocodone/APAP - started at 5/500 3-4x/day, now at 7.5/500 3-4x/day
it works to bring pain to tolerable level but does not get rid of it enough for me to do much moving around.

Ultram - 100mg 3-4x/day (I'm *supposed* to take no more than 6 50mg tabs a day, but find myself trying to take it instead of the Hydrocodone so I don't run out of hydrocodone before the doc will refill.)

The P.A. who has been prescribing/refilling my hydrocodone did offer oxycodone at one point, but I am terrified of becoming addicted. Isn't that a common addiction? I've never been addicted to anything before, unless you count cigarettes ( I quit smoking 18 months ago) but I can fully understand how one can so enjoy the relief from pain that they become addicted to the source of relief! I may be 'addicted' to my heating pads! (see below)

ICE- doesn't work for me at all, in fact, cold, as it is here in KS, makes it worse.

I have been b#tched at for sitting on my heating pads because it does eventually burn my skin, but the heat is literally the best help there is-
If I go to the store, even medicated, for an hour, I ache so bad I am in tears by the time I get home, and cannot wait to get back on the heat to relieve some of the pain.

That's why I wondered if ultrasound therapy might help. A friend gave me an Amazon gift certificate for Christmas, and I've seen some relatively inexpensive TENS units and Ultrasound therapy machines there, but I just don't know if they'd work or specifically how to use them.

If anyone knows how to use these things, please let me know, and if anyone knows any specific stretches or exercises or anything at all that can help, I'm all ears!
THANKS TO ALL !

What kind of workup have you had for your injury?? MRI?? Nerve conduction studies?? Sounds like you have been tried on the proper medications for neuropathic pain/sciatica. Lots of times meds are done on a trial and error basis to see what works best for you.

Addiction is a psychological condition and must be differentiated from tolerance to narcotic medications. Most everyone will develop a tolerance to narcotics, meaning you need higher and higher doses to achieve the same effect.

Studies done so far-

The injury occurred on 9/12/08, and we did an MRI on my right calf in Oct 08 -at the time, the calf was the painful area, not my back. The calf MRI was normal, but an orthopedic specialist said it could have been a partial tear of the gastroc muscle that had already healed by the time they got around to doing an MRI.

About a month later (Nov. 08) my back began to hurt, and the original thought was that it was simply from my altered gait (limping and dragging my leg) from the calf injury.

Then in March 09, a lumbar MRI was done, showing "slight disc bulge at l5-s1" and degeneration in the facet joints at l4-l5-s1(?). The radiologist indicated that while this could cause some discomfort associated with aging (at the time I was 36) but should not cause my intense symptoms.

In April 09, I was examined by a spine specialist, who did only x-rays and said my discs at l4-l5 and l5-s1 looked "like flat tires". but that I was not a candidate for surgery. He asked if I was open to steroid shots, which I agreed I would be, but then they were never done, mainly because with WC, there's not a "regular" provider to provide ongoing treatment, and when we went back to court, the judge sent me somewhere else entirely.

So Nov. 2009 I have an EMG with a Doc hired by the ins co., she says it's 'normal' and shows nothing, but the official report received by my lawyer says that there is some nerve damage or issues on the left leg. (The right leg is the problem :confused: )

Nothing else getting done....until, Spring 2010, we go back to court, and I protest to my lawyer that there has to be SOMETHING that can be done, so my lawyer sends me to a physiatrist/pain management dr for evaluation. (In WC eval. means he can't treat me, just tell the court what I need, and then we hope the court makes the ins. co pay to get me that treatment somewhere else.) This physiatrist says I have a "severely bad disc", recommends ongoing chronic pain management and consideration of a SCS implant, a discograph, and possible spinal fusion surgery dependent on results of discograph.

So then the ins co sends me to another dr hired by them to say the opposite of what my lawyer's dr says...this guy, formerly with NASA, says I may have "post polio syndrome" (:confused: I have NEVER had polio) or something else that would not be related to work injury. Thats what it all comes down to for them, not whether I'm hurt, but whether they can say it wasn't their problem. (which, I was FINE before 9/12/08, worked as a custodian 10 hrs/day 6 days a week, lifting tables over my head! and on my feet all day every day!)

So then, back to court we go! A few months ago we went back to court, and the judge ordered that my local PA, who wasn't the 'authorized treating provider' for WC, but who had been refilling my scripts for 2 yrs, is now 'authorized to continue pain management'. So now they'll actually pay him for what he's done for 2 years, but, as far as I know, no discograph or further investigative tests or whatever. I think we're at a stand still.

Which is again, why I'm here. If the PA is finally authorized to provide pain management, I'm pretty sure he'll do whatever I ask him to try, so I just wanted some ideas to throw at him for things that may help and eventually get me back to normal, or at least off meds?

Dearheart, you will NOT become addicted if you take your medications ONLY as prescribed!! You will become physically dependent, which is a WHOLE LOT different than addiction!!! With addiction, you crave the meds, you will do anything to get them, you think of nothing else. With physical dependence, your body is just used to having the meds and you go thru withdrawal when you stop taking them. That's all. That's why you have to WEAN off them when you stop taking them. There is NO craving, etc.

So you should have no problem taking Oxycodone, or any of the other long acting medications. Most of chronic pain patients take them and we can't ALL be addicts! LOL

I wish you the very best of luck. I hope you can get a handle on your pain. God bless. Hugs, Lee