Sciatica Pain: Causes, Symptoms, and Treatments

July 7, 2014February 17, 2016 / Thomas Cohn, MD

Sciatica is a term used to describe pain that radiates down the back of the leg. The name comes from the main large nerve, the sciatic nerve, that travels from the pelvis down the back of the leg. The sciatic nerve forms from the nerve roots in the lumbar and sacral region of the spine, and it is home to the motor and sensory nerves of the leg. The term sciatica is used to describe the sensation of pain in the leg generally from the buttock to the foot.

Causes of Sciatica

The causes of sciatica are numerous, and they are often the same causes of most low back and leg pain. Any structure that relays sensation through the sciatic nerve can produce sciatica pain. Low back, gluteal (butt), and leg muscles when irritated or strained, tendons, bones, and nerves can all produce these sensations. The pain can be acute or it can be chronic. Everyone describes their pain in different terms, as it is a personal experience. Most of these pains are self-limited, temporary and often resolve quickly within days with rest and possibly over-the-counter medications, heat or ice.

If the pain is due to trauma or is not resolving in a week or two, then seeing a physician may be worthwhile. The benefit of seeing a doctor is to get a good treatment strategy to resolve the problem as quickly and easily as possible. A full medical history, a history about the onset and course of the symptoms, and what has been done in treatment is necessary. An accompanying exam will include looking at the low back, pelvis, legs, and evaluating all the structures, including performing test of muscles, joints, nerves, and overall neurologic status. From a history and exam, a good physician can determine a starting diagnosis and treatment plan. 98% of the issues should resolve with good conservative treatment such as ice, heat, over-the-counter medications, physical therapy, massage and manipulation or adjustments. X-rays, CT scans and MRI scans early on in treatment are usually not necessary.

Long-Term Treatment

If the sciatica is continuing despite conservative care for 6-8 weeks, then the skills of a Physical Medicine and Rehabilitation Pain Specialist can be especially beneficial. These physicians are experts in musculoskeletal medicine and can usually figure out what is wrong and the best treatment options for you that will help resolve the problems. They also can determine if further tests are necessary such as MRI scans or nerve studies, and they can also perform specialized injections that may speed the healing. There are many physicians that treat back pain, but a Physical Medicine Pain Specialist has the added expertise needed to help find the conservative options and guide the decisions for the more complex problems when issues are prolonged.

Sciatica pain can be especially challenging, especially since 85% of the population does have this problem at some point in their lives. If the simple treatment is not working, the best solution is finding the expert with experience. Every person has different circumstances, and a pain specialist has the broadest set of tools to find the matching solution to each puzzle.

Medical Marijuana For Chronic Pain in Minnesota

July 2, 2014 / Thomas Cohn, MD

Minnesota has taken a conservative approach to the use of marijuana for medical purposes. Only a little quality research has been done with regards to the use of marijuana for pain. Most of these studies have been done for patients with cancer or eye problems, and current research is focused on seizures.

The reason why marijuana research is moving slowly is because there are all over 100 compounds that may be an active in cannabis. Most medical professionals would like to know both the positive and negative aspects of any intervention. Since there is no significant marijuana research available, it is hard for medical professionals to recommend the use of this compound.

Marijuana in Minnesota

Minnesota’s new marijuana laws allow the use of marijuana for only limited medical diagnoses. At this time, chronic pain is not included in the list of treatment recommendations. Chronic pain is extremely complex, and has multiple causes in most people. A single compound like marijuana is unlikely to be helpful and every person. Determining which group of patients would be helped by such a compound will be difficult due to the variety of conditions that cause pain.

Most physicians in Minnesota will not be prescribing medical marijuana. If you have chronic pain, do not expect a physician to write you a prescription for marijuana, especially since it isn’t approved for recreational use in Minnesota or even nationally. Furthermore, the drug enforcement administration (DEA) can stop a physician from being able to prescribe any medications if they prescribe to known drug abusers. The use of marijuana is not considered a legal medication, and physicians can lose their license if they prescribe to a patient who abuses marijuana.

Alleviating Symptoms

Pain symptoms in some patients may seem to improve with the use of marijuana. There are many compounds in marijuana that may help control a variety of symptoms including anxiety and pain. Most physicians who are prescribing control medications such as narcotics will do a urine drug screen to determine whether street drugs are being used by the patient. Most physicians have a zero tolerance rule for the use of street drugs since they could lose their license if they prescribe to an abuser. If you use marijuana, do not expect to be prescribed narcotic medication. Most pain physicians will work with you to control your symptoms with other treatments that are very effective in managing your problems.

In the distant future, when we know which compounds in marijuana are effective, we may be able to develop more comprehensive treatment plans for patients with chronic pain. Until that time, hopefully the change in laws will promote good research with regards to the active compounds that will be effective in managing pain. More tools to treat pain will always be helpful. Unfortunately, research takes time and these new compounds may take up to 10 years or longer to develop.

Sex and Chronic Pain

June 30, 2014February 17, 2016 / Thomas Cohn, MD

Many patients who have chronic pain say they have no interest in sex, that sexual intercourse causes too much pain, or that they feel unattractive or undesirable because of the pain. It’s important to remember that emotional intimacy is as important as food and shelter for overall health. Sexuality is a normal part of living and is an important aspect of your identity. Chronic pain often invades the pleasures of life and destroys your sexuality.

Chronic pain affects the patient emotionally and physically. The psychological problems that chronic pain causes include:

Stress
Depression
Anxiety
Diminished self-esteem

If the brain cannot desire sex, the body certainly will not perform. The core problem may simply be the pain, but often it is much more complex. Receiving help requires the patient to identify that they are having sexual issues.

The most common direct causes of sexual problems include too much pain and medication side effects. Adjusting pain treatments may be the only necessary intervention. It also may be necessary to become more aggressive in the overall management and intervention for the painful condition. Many medications used in pain management (as well as medications for common problems) can cause sexual problems, including narcotics, anti-inflammatories and even antidepressants. A comprehensive strategy may be necessary and working with a pain physician may be the best approach.

Emotional Issues

Chronic pain often causes emotional problems, including stress, anxiety and depression. These problems all contribute to sexual difficulties. Until the psychological issues are being addressed successfully, it is often hard to control pain and have interest in sex. If simple medication management is not controlling emotional issues, professional help with a psychologist may be extremely beneficial.

Working with your partner is also necessary, especially when it comes to expressing your needs and concerns. Doctors cannot read your mind and if you do not tell them you are having problems, they will not be able to help you develop solutions. A comprehensive approach will often be necessary, since most problems involve a complex interaction between the emotional and physical causes. Working closely with your partner and professionals is often the solution. Most problems can be greatly improved with a little bit of support and creativity.

Pain Making it Hard To Sleep? We Can Help

June 25, 2014 / Thomas Cohn, MD

Pain often causes sleep problems. In patients with chronic pain, sleep problems occur in over 50 percent of patients. Problems with sleep can worsen pain and affect your whole life. Patients will often feel rundown, tired, depressed and very stressed. Relationships with your family, your spouse, and at work may be affected. Solving the issue if a complex process, and it won’t happen overnight.

4 Pain-Related Sleep Problems

Sleep problems can be divided into four categories:

Pain making it difficult to fall asleep
Chronic pain causing frequent awakening during the night
Pain may prevent restorative deep sleep
Waking up too early each morning because pain makes it impossible to fall back asleep

Each type of problem may need a different solution, and patients often experience more than one of the above conditions. The first step in treating the issue is by practicing good sleep hygiene. Activities that cause problems prior to sleeping include drinking caffeinated beverages and alcohol. Alcohol may initially cause tiredness but later in the night often disrupts sleep cycles.

Exercising late at night is another no-no. Exercise will help keep you awake, and napping during the day may also lead to decreased tiredness. The bedroom should be considered place only for sleeping and not for watching TV or doing work-related activities. The bedroom should be considered a calming and relaxing place.

Physician Treatment

When the simple things and conservative treatment does not help improve sleep, working with your physician for a more comprehensive treatment strategy is beneficial. A sleep study is often especially helpful in determining the issues that are preventing good sleep, and they can help formulate a plan to combat the problem. Multiple medications are available to help with sleep, but many can actually interfere with parts of this sleep cycle. Narcotic medications and older antidepressants may help with pain at night but often interfere with portions of the deep sleep cycle. Newer medications like Ambien and Lunesta are helpful in allowing the patient to fall asleep, but may not be helpful to keep a person asleep. Recently, melatonin at doses of 5-10 mg has been found to be helpful in maintaining good sleep cycles and reducing pain. Sleep studies can also be helpful to determine other medical problems that need to be treated to improve sleep.

Chronic pain often interferes with sleep, and poor sleep can lead to worsening pain. Improving sleep at night can often greatly improve the quality of life. Sleep problems can be simple, but often with chronic pain they are complex. A sleep study is sometimes needed to determine all problems associated with the lack of sleep. The solution to a good night sleep may require multiple changes and routines. The help of a pain specialist or a sleep expert may be necessary to find the right solution.

Dr. Cohn Out of Office Until July 7

June 23, 2014June 23, 2014 / Thomas Cohn, MD

I wanted to take a moment to let my readers and patients know that I’ll be out of the office from June 21 through July 6. I will be going on vacation for a portion of that time, and I’ll be unable to be contacted for most of that duration. I will begin seeing patients again at the CDI Sartell office on July 7th.

If you have immediate needs during that time please contact Dr. Robert Long or his assistant Julie Marden by calling 952-738-4456. If you want to set up an appointment with me when I get back, call the main office number at 320-251-0609.

After Hours Calls

If you want to set up an appointment after the office has closed for the day, you’ll need to follow the after hours procedure. We always have a doctor on call in case something arises. Dr. Long and Dr. Kim will be the on call physicians in my absence. They are wonderful doctors and are more than capable of providing you with the care you need.

I have written some blog posts to be shared while I am on vacation, so there will continue to be new stories on the blog as well as activity on my social media profiles. So while you will continue to see activity, remember that I will be unable to personally answer any questions that may be submitted through Facebook or on a blog post. I’ll answer your questions when I get back, and if it’s a serious concern please call CDI. They’ll make sure you get the care you deserve.

Thanks,

Dr. Thomas Cohn.

P.S. I meant for this post to appear on Friday, but we are currently in the process of switching to a self-hosted server. This created a visibility issue for this post on Friday. I apologize for any inconvenience.