Treatment Options for Chronic Sciatica and Lower Back Pain

A physician answers patient questions about conservative treatments for chronic back pain and sciatica.

Question:

I am a 43 yr old male. My MRI shows degenerative disc disease and anterior and posterior disc bulge at L2-3, L3-4, L4-5 and L5-S1. I have constant lower back pain and have periodic bouts of right leg sciatica. I take regular pain relieving medication and use a TENS device.

I have undergone physical therapy, osteopathy, several forms of chiropractic, pain relief therapy, and acupuncture. None resulted in more than a very short-term lessening of the low back pain and sciatica. I have also had epidural and facet joint injections, which had no effect.

Are any options available which could lessen the lower back pain and sciatica and allow me greater control over my life?

Doctor's response:

Multi-level disc space degeneration is a difficult problem to handle because there are no good surgical solutions to fix the problem. Fusing the entire spine eliminates too much motion and changes the biomechanics of the back too much. This generally leaves one with only conservative pain management techniques. The good news is that it is not a crippling condition, and even if the sciatica and low back pain seem worse at times, it does not necessarily mean that your back or the condition is worsening.

Generally, your best bet is a strict home exercise program that emphasizes stretching your hamstring muscles as well as aerobic conditioning and stabilization exercises. This can help compensate for the bad discs, and even if it is not a cure it can keep you functional and keep the pain from getting worse. Unfortunately, the exercises themselves may be uncomfortable to do, but you should notice that as you get stronger and stretched out the pain will not be as bad and you will be able to function better.

It is best to work one on one with a physical therapist who specializes in the treatment of chronic pain. If you have had chronic pain you should also be under the care of a conservative care spine specialist, such as a physiatrist.

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• Article written By:
• Peter F. Ullrich, Jr., MD

March 9, 2009

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