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Doctors' Answers to "Frequently Asked Questions" - Sciatica

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 11/8/1999]
Question: I suffer from acute sciatic pain in my right leg. It has now started in my left leg and I am seeing a Neurologist this week to see if there is a reasonable suggestion to help alleviate the pain. I have had 9 back operations including fusion, bone grafts and the insertion of 2 metal plates and 10 screws to stop the disc protusion at levels L4,5 and S1. I had to have the plates and screws removed as one of the right side screws was sitting on my sciatic nerve and one of the screws on the left side was penetrating my womb. I am now in constant sciatic pain which was only in the right leg but has now moved to the left leg. I guess I'm looking for an answer other than living on MS Contin and Valium as I find it extremely hard to function and run my Company whilst I am so drugged. It has been suggested that perhaps a nerve block or cutting the sympathetic nerve may help so I am curious to seek a second opinion. If there is anything else you could recommend or suggest it would be greatly appreciated.
Thanking you in anticipation of a favourable reply.

Answer: I assume you have seen a pain specialist? This would be the next option if you have not.

Sciatica Treatment [posted 1/5/99]
Question: I recently had a bad bout with Sciatica and ended up with a diagnosis of narrowing of the space between L5 and S1. I also was left with the bottom of my left foot numb and a lot of pain. After trying Vicodin, which was no help, I saw a Neurologist who prescribed Neurontin. Up to 3, 300 mg pills a day. It helps the pain. Now I am starting to take Ultram as part of a clinical study. Should I quit the neurontin? I am trying the ultram as a last chance before two TKRs. I am in my late 50s, in good shape, and quite active.

Answer: Why quit if what works? If you check these questions, you will see a lot of people who wish that something would work.

Sciatica, Effexor, and Tegretol [posted 7/23/98]
Question: My 65 year old mother had surgery for a baker's cyst 2 years ago and has been in constant pain since then. She has been through several procedures to determine what exactly is the source of this pain. One of her doctors (in her HMO) thinks she has Sciatica, which may have been her original problem. Most recently she was put on Effexor by one doctor and Tegretol by another. What is the Effexor for and is there any contraindications between these 2 drugs? Also, do you have any input on how to manage sciatica pain?

Answer: Effexor and Tegretol are used for several purposes, but in this context, for management of chronic pain. There is no obvious problem with taking the combination. Sciatica is sometimes difficult to manage. I assume she has had Physical Therapy, heat, ultrasonics and an aggressive trial of Non-Steroidal Anti-Inflammatories? Next would be Nerve stimulators, local steroid injections (or possibly epidural injections). Also, has she had a CT of her back or EMGs to determine the point source of the pain? Sounds like they are not completely sure where the nerve is being irritated. I would ensure this is done.

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