Tag Archives: spinal stenosis

Straight, No Chaser: When Back Pain Could Be Life Threatening

Emergency

Back pain hurts, but there are various causes of that pain that will kill or cripple you.  Here’s some information on some diseases that present with back pain representing life-threats.  Be advised that as an Emergency Physician, my initial orientation is more toward ruling out the life-threatening consideration than making a definitive diagnosis, which comes afterwards.  Forewarned is forearmed.

Let’s start where we left off on post discussion general low back pain and identify what I was talking about….

Here are a few clues to help you hone in on whether your back pain requires emergency attention.  Remember pain and pathology (serious disease) are two different considerations.  I’m describing medical emergencies here and admittedly being overly simplistic.

  • Direct blow to your back:  Think Fracture
    • The trauma literature suggests that most motor vehicle collisions don’t have enough direct force to break your back.  It’s suggested that the force of a baseball bat is needed to break something in your back if you were previously healthy.  That said, the consequences of fracture are such that direct back trauma from a fall or other direct blow are such that you should at least be evaluated.
  • Fever and new onset back pain: Think Spinal Epidural Abscess
    • A spinal epidural abscess is a ‘pus pocket’ (i.e. infection) that collects between the spinal cord’s outer covering and the bones.  It can result from a recent back surgery, a back boil, a bony spinal infection (vertebral osteomyelitis), from IV drug abuse, or as part of an infection otherwise delivered from the blood.  Antibiotics for about a month and/or surgery may be required.
  • Loss of control of your bowel movements or bladder: Think Cauda Equina Syndrome (CES)
    • There are many neurologic causes of low back pain, but the ones associated with ‘hard’ neurologic findings represent true medical emergencies.  CES is caused by something compressing on the spinal nerve roots, like a ruptured lumbar disk, a tumor, infection, bleeding or fracture or various birth defects.  This could lead to loss of bowel and bladder control and possibly permanent paralysis of your legs.  Again, there are several other causes of these symptoms, but for the purposes of this blog, get evaluated quickly, and let us figure out whether this or something else is going on.
  • New onset back pain after age 65: Think Cancer
    • There are several considerations in play when it comes to back pain in the elderly, including fractures and arthritis, but the life-threatening consideration I’m focusing on is cancer.  The spine is a common place for cancer cells to metastasize; in fact approximately 70% of patients with metastatic cancer will have spinal involvement.  Given that only about 10% of these patients tend to be initially symptomatic, it’s imperative that you get evaluated if symptoms present.  It could represent a significant advancement of disease.
  • Numbness and tingling in both of your legs: see Cauda Equina Syndrome above
  • Night-time back pain: Think Metastatic Cancer.
    • Bone pain at night in a patient previously diagnosed with cancer is the most ominous symptom in patient with metastatic cancer, that which spreads throughout the body.
  • Sudden sexual dysfunction: See Cauda Equina Syndrome above
  • Weakness and/or loss of motion or sensation in your legs: See Cauda Equina Syndrome above
  • Unexplained new weight loss and new onset back pain: Think Cancer
    • There are a few considerations here, but I’m focusing on the life threatening consideration and working backwards from there.
  • Work-related back injuries
    • This isn’t as much a life-threatening consideration as it is a limb and career-threatening one.  Given the degree of disability that is work-related and the need to continue working at the same level of productivity required to keep your job, it’s a pretty good idea to have incremental changes in symptoms and function assessed.  Ignoring symptoms when they occur can lead to failure to qualify for worker’s compensation, not to mention it places you at risk for worsening injuries and ongoing disability.

Other diseases present with back pain, including kidney stones and infection, pancreatitis and certain ruptured abdominal organs.  I’d like to make special mention of the latter, which may include abdominal aortic aneurysms and ectopic pregnancies, both of which I’ll address in the future.  The take home consideration here is to use these cues to know when to get rapidly evaluated.  Even though people use the Emergency Room for seemingly everything these days, knowing when time is of the essence for true emergencies is a life-saver.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Copyright © 2018 · Sterling Initiatives, LLC · Powered by WordPress

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Comments Off on Straight, No Chaser: When Back Pain Could Be Life Threatening

Filed under Neurology, Orthopedics/Bones

Straight, No Chaser: Sciatica

Sciatica

My pain has a name, and it’s sciatica. There’s always a sense of relief in patients when a name is given to a medical sign or symptom. This Straight, No Chaser places sciatica in context among various problems of the low back and gives you basic information for you to use in seeking solutions.

What is sciatica?

sciatica nerve

This is important for you to understand. Sciatica is a symptom, not a diagnosis. Sciatica is any of various clinical presentations that result from any injury to or inflammation of the sciatic nerve. The sciatic nerve is a large nerve that extends from the lower back and travels down the back of each of your legs. This nerve provides muscle control and sensation to various parts of your thighs, legs and soles of your feet.

What are the symptoms of sciatica?

sciatica screams

Once you know the distribution of the sciatic nerve, the symptoms are pretty self-evident. Simplistically, a nerve is just an electrical conductor sending signals down its distribution. The typical symptoms of sciatica include the following:

  • Pain (e.g. pins and needles, burning or aching)
  • Weakness (can progress to an outright inability to move)
  • Numbness
  • Tingling

The discomfort usually occurs on one side and worsens under certain conditions, such as the following:

  • After sneezing, coughing or laughing
  • After walking or bending backwards
  • At night
  • When standing or sitting

What causes sciatica?

sciatica spinal stenosis

If you ever get diagnosed with sciatica, your immediate next question should be “What’s next?” Be reminded, sciatica is caused by something causing irritation, inflammation or injury to the sciatic nerves. Here are some common and/or important causes of sciatica; feel free to ask your physician if these actual diagnoses are being considered if you’re told you have sciatica.

  • Bruise or fracture to one of your pelvic bones
  • Degenerative disc disease (erosion of the cushions between your vertebrae/spine; this naturally occurs with aging)
  • Infection (a rare but important cause in those with new fever and back pain)
  • Piriformis syndrome (this buttock muscle can irritate or pinch a nerve root than leads to the sciatic nerve)
  • Pregnancy
  • Slipped/herniated disk (aka pinched nerve; sciatica is the most common symptom of this condition)
  • Spinal stenosis (narrowing of the spinal canal in the lower back; it’s relatively common over age 60)
  • Spondylolisthesis (the slipping of one vertebrae/spinal bone forward over another one; it’s usually associated with a small stress fracture)
  • Tumors (this is rare; please don’t assume you have cancer if you have back pain, but do ask if your doctor has considered it if you develop new back pain after age 50. Accept “you don’t have it” as good news). 

How is sciatica treated?

If you actually have sciatica, treatment begins with identifying the underlying cause. Here are some general principles of treatment.

SCIATICA PAIN RELIEF

  • In some cases, no treatment is required and recovery occurs on its own.
  • Non-surgical treatment is best in many cases. You likely will be told to apply ice for the first 48-72 hours then use heat to reduce inflammation.
  • Over-the-counter pain medicines such as ibuprofen (aka Advil, Motrin) or acetaminophen (aka Tylenol) are the medicines you should be using. Narcotics too often are a slippery slope that are unnecessary and don’t actually address inflammation when it is a causal factor.
  • Reduced and limited activity is best for the first few days. Bed rest is not recommended.

Sciatica treatment

  • For the first 6 weeks of symptoms, you should not engage in heavy lifting or twisting of your back.
  • Wait 2-3 weeks to restart exercising. Focus on exercises that strengthen your abdomen and improve flexibility of your spine. Exercises are best if part of physical therapy.
  • Many of you try to jump straight to such measures as injection of medicines, acupuncture, chiropractic manipulation or surgery. If these measures are needed, your physician will direct if and when they will be beneficial.
  • Similarly if you have ongoing problems, your physician may refer you to a neurologist or pain specialist.

Tomorrow’s Straight, No Chaser post will focus on life-threatening causes of sciatica and other back pain. There are specific symptoms that should prompt an immediate visit to your physician or emergency room. Be sure to check back, and be aware.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Copyright © 2018 · Sterling Initiatives, LLC · Powered by WordPress

1 Comment

Filed under Musculoskeletal System, Neurology

Straight, No Chaser: When Back Pain Could Be Life Threatening

Emergency

Back pain hurts, but there are various causes of that pain that will kill or cripple you.  Here’s some information on some diseases that present with back pain representing life-threats.  Be advised that as an Emergency Physician, my initial orientation is more toward ruling out the life-threatening consideration than making a definitive diagnosis, which comes afterwards.  Forewarned is forearmed.

Let’s start where we left off on post discussion general low back pain and identify what I was talking about….

Here are a few clues to help you hone in on whether your back pain requires emergency attention.  Remember pain and pathology (serious disease) are two different considerations.  I’m describing medical emergencies here and admittedly being overly simplistic.

  • Direct blow to your back:  Think Fracture
    • The trauma literature suggests that most motor vehicle collisions don’t have enough direct force to break your back.  It’s suggested that the force of a baseball bat is needed to break something in your back if you were previously healthy.  That said, the consequences of fracture are such that direct back trauma from a fall or other direct blow are such that you should at least be evaluated.
  • Fever and new onset back pain: Think Spinal Epidural Abscess
    • A spinal epidural abscess is a ‘pus pocket’ (i.e. infection) that collects between the spinal cord’s outer covering and the bones.  It can result from a recent back surgery, a back boil, a bony spinal infection (vertebral osteomyelitis), from IV drug abuse, or as part of an infection otherwise delivered from the blood.  Antibiotics for about a month and/or surgery may be required.
  • Loss of control of your bowel movements or bladder: Think Cauda Equina Syndrome (CES)
    • There are many neurologic causes of low back pain, but the ones associated with ‘hard’ neurologic findings represent true medical emergencies.  CES is caused by something compressing on the spinal nerve roots, like a ruptured lumbar disk, a tumor, infection, bleeding or fracture or various birth defects.  This could lead to loss of bowel and bladder control and possibly permanent paralysis of your legs.  Again, there are several other causes of these symptoms, but for the purposes of this blog, get evaluated quickly, and let us figure out whether this or something else is going on.
  • New onset back pain after age 65: Think Cancer
    • There are several considerations in play when it comes to back pain in the elderly, including fractures and arthritis, but the life-threatening consideration I’m focusing on is cancer.  The spine is a common place for cancer cells to metastasize; in fact approximately 70% of patients with metastatic cancer will have spinal involvement.  Given that only about 10% of these patients tend to be initially symptomatic, it’s imperative that you get evaluated if symptoms present.  It could represent a significant advancement of disease.
  • Numbness and tingling in both of your legs: see Cauda Equina Syndrome above
  • Night-time back pain: Think Metastatic Cancer.
    • Bone pain at night in a patient previously diagnosed with cancer is the most ominous symptom in patient with metastatic cancer, that which spreads throughout the body.
  • Sudden sexual dysfunction: See Cauda Equina Syndrome above
  • Weakness and/or loss of motion or sensation in your legs: See Cauda Equina Syndrome above
  • Unexplained new weight loss and new onset back pain: Think Cancer
    • There are a few considerations here, but I’m focusing on the life threatening consideration and working backwards from there.
  • Work-related back injuries
    • This isn’t as much a life-threatening consideration as it is a limb and career-threatening one.  Given the degree of disability that is work-related and the need to continue working at the same level of productivity required to keep your job, it’s a pretty good idea to have incremental changes in symptoms and function assessed.  Ignoring symptoms when they occur can lead to failure to qualify for worker’s compensation, not to mention it places you at risk for worsening injuries and ongoing disability.

Other diseases present with back pain, including kidney stones and infection, pancreatitis and certain ruptured abdominal organs.  I’d like to make special mention of the latter, which may include abdominal aortic aneurysms and ectopic pregnancies, both of which I’ll address in the future.  The take home consideration here is to use these cues to know when to get rapidly evaluated.  Even though people use the Emergency Room for seemingly everything these days, knowing when time is of the essence for true emergencies is a life-saver.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Comments Off on Straight, No Chaser: When Back Pain Could Be Life Threatening

Filed under Neurology, Orthopedics/Bones

Straight, No Chaser: Sciatica

Sciatica

My pain has a name, and it’s sciatica. There’s always a sense of relief in patients when a name is given to a medical sign or symptom. This Straight, No Chaser places sciatica in context among various problems of the low back and gives you basic information for you to use in seeking solutions.

What is sciatica?

sciatica nerve

This is important for you to understand. Sciatica is a symptom, not a diagnosis. Sciatica is any of various clinical presentations that result from any injury to or inflammation of the sciatic nerve. The sciatic nerve is a large nerve that extends from the lower back and travels down the back of each of your legs. This nerve provides muscle control and sensation to various parts of your thighs, legs and soles of your feet.

What are the symptoms of sciatica?

sciatica screams

Once you know the distribution of the sciatic nerve, the symptoms are pretty self-evident. Simplistically, a nerve is just an electrical conductor sending signals down its distribution. The typical symptoms of sciatica include the following:

  • Pain (e.g. pins and needles, burning or aching)
  • Weakness (can progress to an outright inability to move)
  • Numbness
  • Tingling

The discomfort usually occurs on one side and worsens under certain conditions, such as the following:

  • After sneezing, coughing or laughing
  • After walking or bending backwards
  • At night
  • When standing or sitting

What causes sciatica?

sciatica spinal stenosis

If you ever get diagnosed with sciatica, your immediate next question should be “What’s next?” Be reminded, sciatica is caused by something causing irritation, inflammation or injury to the sciatic nerves. Here are some common and/or important causes of sciatica; feel free to ask your physician if these actual diagnoses are being considered if you’re told you have sciatica.

  • Bruise or fracture to one of your pelvic bones
  • Degenerative disc disease (erosion of the cushions between your vertebrae/spine; this naturally occurs with aging)
  • Infection (a rare but important cause in those with new fever and back pain)
  • Piriformis syndrome (this buttock muscle can irritate or pinch a nerve root than leads to the sciatic nerve)
  • Pregnancy
  • Slipped/herniated disk (aka pinched nerve; sciatica is the most common symptom of this condition)
  • Spinal stenosis (narrowing of the spinal canal in the lower back; it’s relatively common over age 60)
  • Spondylolisthesis (the slipping of one vertebrae/spinal bone forward over another one; it’s usually associated with a small stress fracture)
  • Tumors (this is rare; please don’t assume you have cancer if you have back pain, but do ask if your doctor has considered it if you develop new back pain after age 50. Accept “you don’t have it” as good news). 

How is sciatica treated?

If you actually have sciatica, treatment begins with identifying the underlying cause. Here are some general principles of treatment.

SCIATICA PAIN RELIEF

  • In some cases, no treatment is required and recovery occurs on its own.
  • Non-surgical treatment is best in many cases. You likely will be told to apply ice for the first 48-72 hours then use heat to reduce inflammation.
  • Over-the-counter pain medicines such as ibuprofen (aka Advil, Motrin) or acetaminophen (aka Tylenol) are the medicines you should be using. Narcotics too often are a slippery slope that are unnecessary and don’t actually address inflammation when it is a causal factor.
  • Reduced and limited activity is best for the first few days. Bed rest is not recommended.

Sciatica treatment

  • For the first 6 weeks of symptoms, you should not engage in heavy lifting or twisting of your back.
  • Wait 2-3 weeks to restart exercising. Focus on exercises that strengthen your abdomen and improve flexibility of your spine. Exercises are best if part of physical therapy.
  • Many of you try to jump straight to such measures as injection of medicines, acupuncture, chiropractic manipulation or surgery. If these measures are needed, your physician will direct if and when they will be beneficial.
  • Similarly if you have ongoing problems, your physician may refer you to a neurologist or pain specialist.

Tomorrow’s Straight, No Chaser post will focus on life-threatening causes of sciatica and other back pain. There are specific symptoms that should prompt an immediate visit to your physician or emergency room. Be sure to check back, and be aware.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Comments Off on Straight, No Chaser: Sciatica

Filed under Musculoskeletal System, Neurology

Straight, No Chaser: When Back Pain Could Be Life Threatening

Emergency

Back pain hurts, but there are various causes of that pain that will kill or cripple you.  Here’s some information on some diseases that present with back pain representing life-threats.  Be advised that as an Emergency Physician, my initial orientation is more toward ruling out the life-threatening consideration than making a definitive diagnosis, which comes afterwards.  Forewarned is forearmed.

Let’s start where we left off on post discussion general low back pain and identify what I was talking about….

Here are a few clues to help you hone in on whether your back pain requires emergency attention.  Remember pain and pathology (serious disease) are two different considerations.  I’m describing medical emergencies here and admittedly being overly simplistic.

  • Direct blow to your back:  Think Fracture
    • The trauma literature suggests that most motor vehicle collisions don’t have enough direct force to break your back.  It’s suggested that the force of a baseball bat is needed to break something in your back if you were previously healthy.  That said, the consequences of fracture are such that direct back trauma from a fall or other direct blow are such that you should at least be evaluated.
  • Fever and new onset back pain: Think Spinal Epidural Abscess
    • A spinal epidural abscess is a ‘pus pocket’ (i.e. infection) that collects between the spinal cord’s outer covering and the bones.  It can result from a recent back surgery, a back boil, a bony spinal infection (vertebral osteomyelitis), from IV drug abuse, or as part of an infection otherwise delivered from the blood.  Antibiotics for about a month and/or surgery may be required.
  • Loss of control of your bowel movements or bladder: Think Cauda Equina Syndrome (CES)
    • There are many neurologic causes of low back pain, but the ones associated with ‘hard’ neurologic findings represent true medical emergencies.  CES is caused by something compressing on the spinal nerve roots, like a ruptured lumbar disk, a tumor, infection, bleeding or fracture or various birth defects.  This could lead to loss of bowel and bladder control and possibly permanent paralysis of your legs.  Again, there are several other causes of these symptoms, but for the purposes of this blog, get evaluated quickly, and let us figure out whether this or something else is going on.
  • New onset back pain after age 65: Think Cancer
    • There are several considerations in play when it comes to back pain in the elderly, including fractures and arthritis, but the life-threatening consideration I’m focusing on is cancer.  The spine is a common place for cancer cells to metastasize; in fact approximately 70% of patients with metastatic cancer will have spinal involvement.  Given that only about 10% of these patients tend to be initially symptomatic, it’s imperative that you get evaluated if symptoms present.  It could represent a significant advancement of disease.
  • Numbness and tingling in both of your legs: see Cauda Equina Syndrome above
  • Night-time back pain: Think Metastatic Cancer.
    • Bone pain at night in a patient previously diagnosed with cancer is the most ominous symptom in patient with metastatic cancer, that which spreads throughout the body.
  • Sudden sexual dysfunction: See Cauda Equina Syndrome above
  • Weakness and/or loss of motion or sensation in your legs: See Cauda Equina Syndrome above
  • Unexplained new weight loss and new onset back pain: Think Cancer
    • There are a few considerations here, but I’m focusing on the life threatening consideration and working backwards from there.
  • Work-related back injuries
    • This isn’t as much a life-threatening consideration as it is a limb and career-threatening one.  Given the degree of disability that is work-related and the need to continue working at the same level of productivity required to keep your job, it’s a pretty good idea to have incremental changes in symptoms and function assessed.  Ignoring symptoms when they occur can lead to failure to qualify for worker’s compensation, not to mention it places you at risk for worsening injuries and ongoing disability.

Other diseases present with back pain, including kidney stones and infection, pancreatitis and certain ruptured abdominal organs.  I’d like to make special mention of the latter, which may include abdominal aortic aneurysms and ectopic pregnancies, both of which I’ll address in the future.  The take home consideration here is to use these cues to know when to get rapidly evaluated.  Even though people use the Emergency Room for seemingly everything these days, knowing when time is of the essence for true emergencies is a life-saver.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

2 Comments

Filed under Neurology, Orthopedics/Bones

Straight, No Chaser: Sciatica

Sciatica

My pain has a name, and it’s sciatica. There’s always a sense of relief in patients when a name is given to a medical sign or symptom. This Straight, No Chaser places sciatica in context among various problems of the low back and gives you basic information for you to use in seeking solutions.

What is sciatica?

sciatica nerve

This is important for you to understand. Sciatica is a symptom, not a diagnosis. Sciatica is any of various clinical presentations that result from any injury to or inflammation of the sciatic nerve. The sciatic nerve is a large nerve that extends from the lower back and travels down the back of each of your legs. This nerve provides muscle control and sensation to various parts of your thighs, legs and soles of your feet.

What are the symptoms of sciatica?

sciatica screams

Once you know the distribution of the sciatic nerve, the symptoms are pretty self-evident. Simplistically, a nerve is just an electrical conductor sending signals down its distribution. The typical symptoms of sciatica include the following:

  • Pain (e.g. pins and needles, burning or aching)
  • Weakness (can progress to an outright inability to move)
  • Numbness
  • Tingling

The discomfort usually occurs on one side and worsens under certain conditions, such as the following:

  • After sneezing, coughing or laughing
  • After walking or bending backwards
  • At night
  • When standing or sitting

What causes sciatica?

sciatica spinal stenosis

If you ever get diagnosed with sciatica, your immediate next question should be “What’s next?” Be reminded, sciatica is caused by something causing irritation, inflammation or injury to the sciatic nerves. Here are some common and/or important causes of sciatica; feel free to ask your physician if these actual diagnoses are being considered if you’re told you have sciatica.

  • Bruise or fracture to one of your pelvic bones
  • Degenerative disc disease (erosion of the cushions between your vertebrae/spine; this naturally occurs with aging)
  • Infection (a rare but important cause in those with new fever and back pain)
  • Piriformis syndrome (this buttock muscle can irritate or pinch a nerve root than leads to the sciatic nerve)
  • Pregnancy
  • Slipped/herniated disk (aka pinched nerve; sciatica is the most common symptom of this condition)
  • Spinal stenosis (narrowing of the spinal canal in the lower back; it’s relatively common over age 60)
  • Spondylolisthesis (the slipping of one vertebrae/spinal bone forward over another one; it’s usually associated with a small stress fracture)
  • Tumors (this is rare; please don’t assume you have cancer if you have back pain, but do ask if your doctor has considered it if you develop new back pain after age 50. Accept “you don’t have it” as good news). 

How is sciatica treated?

If you actually have sciatica, treatment begins with identifying the underlying cause. Here are some general principles of treatment.

SCIATICA PAIN RELIEF

  • In some cases, no treatment is required and recovery occurs on its own.
  • Non-surgical treatment is best in many cases. You likely will be told to apply ice for the first 48-72 hours then use heat to reduce inflammation.
  • Over-the-counter pain medicines such as ibuprofen (aka Advil, Motrin) or acetaminophen (aka Tylenol) are the medicines you should be using. Narcotics too often are a slippery slope that are unnecessary and don’t actually address inflammation when it is a causal factor.
  • Reduced and limited activity is best for the first few days. Bed rest is not recommended.

Sciatica treatment

  • For the first 6 weeks of symptoms, you should not engage in heavy lifting or twisting of your back.
  • Wait 2-3 weeks to restart exercising. Focus on exercises that strengthen your abdomen and improve flexibility of your spine. Exercises are best if part of physical therapy.
  • Many of you try to jump straight to such measures as injection of medicines, acupuncture, chiropractic manipulation or surgery. If these measures are needed, your physician will direct if and when they will be beneficial.
  • Similarly if you have ongoing problems, your physician may refer you to a neurologist or pain specialist.

Tomorrow’s Straight, No Chaser post will focus on life-threatening causes of sciatica and other back pain. There are specific symptoms that should prompt an immediate visit to your physician or emergency room. Be sure to check back, and be aware.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

1 Comment

Filed under Musculoskeletal System, Neurology

Straight, No Chaser: When Back Pain Could Be Life Threatening

Emergency

Back pain hurts, but there are various causes of that pain that will kill or cripple you.  Here’s some information on some diseases that present with back pain representing life-threats.  Be advised that as an Emergency Physician, my initial orientation is more toward ruling out the life-threatening consideration than making a definitive diagnosis, which comes afterwards.  Forewarned is forearmed.

Let’s start where we left off on post discussion general low back pain and identify what I was talking about….

Here are a few clues to help you hone in on whether your back pain requires emergency attention.  Remember pain and pathology (serious disease) are two different considerations.  I’m describing medical emergencies here and admittedly being overly simplistic.

  • Direct blow to your back:  Think Fracture
    • The trauma literature suggests that most motor vehicle collisions don’t have enough direct force to break your back.  It’s suggested that the force of a baseball bat is needed to break something in your back if you were previously healthy.  That said, the consequences of fracture are such that direct back trauma from a fall or other direct blow are such that you should at least be evaluated.
  • Fever and new onset back pain: Think Spinal Epidural Abscess
    • A spinal epidural abscess is a ‘pus pocket’ (i.e. infection) that collects between the spinal cord’s outer covering and the bones.  It can result from a recent back surgery, a back boil, a bony spinal infection (vertebral osteomyelitis), from IV drug abuse, or as part of an infection otherwise delivered from the blood.  Antibiotics for about a month and/or surgery may be required.
  • Loss of control of your bowel movements or bladder: Think Cauda Equina Syndrome (CES)
    • There are many neurologic causes of low back pain, but the ones associated with ‘hard’ neurologic findings represent true medical emergencies.  CES is caused by something compressing on the spinal nerve roots, like a ruptured lumbar disk, a tumor, infection, bleeding or fracture or various birth defects.  This could lead to loss of bowel and bladder control and possibly permanent paralysis of your legs.  Again, there are several other causes of these symptoms, but for the purposes of this blog, get evaluated quickly, and let us figure out whether this or something else is going on.
  • New onset back pain after age 65: Think Cancer
    • There are several considerations in play when it comes to back pain in the elderly, including fractures and arthritis, but the life-threatening consideration I’m focusing on is cancer.  The spine is a common place for cancer cells to metastasize; in fact approximately 70% of patients with metastatic cancer will have spinal involvement.  Given that only about 10% of these patients tend to be initially symptomatic, it’s imperative that you get evaluated if symptoms present.  It could represent a significant advancement of disease.
  • Numbness and tingling in both of your legs: see Cauda Equina Syndrome above
  • Night-time back pain: Think Metastatic Cancer.
    • Bone pain at night in a patient previously diagnosed with cancer is the most ominous symptom in patient with metastatic cancer, that which spreads throughout the body.
  • Sudden sexual dysfunction: See Cauda Equina Syndrome above
  • Weakness and/or loss of motion or sensation in your legs: See Cauda Equina Syndrome above
  • Unexplained new weight loss and new onset back pain: Think Cancer
    • There are a few considerations here, but I’m focusing on the life threatening consideration and working backwards from there.
  • Work-related back injuries
    • This isn’t as much a life-threatening consideration as it is a limb and career-threatening one.  Given the degree of disability that is work-related and the need to continue working at the same level of productivity required to keep your job, it’s a pretty good idea to have incremental changes in symptoms and function assessed.  Ignoring symptoms when they occur can lead to failure to qualify for worker’s compensation, not to mention it places you at risk for worsening injuries and ongoing disability.

Other diseases present with back pain, including kidney stones and infection, pancreatitis and certain ruptured abdominal organs.  I’d like to make special mention of the latter, which may include abdominal aortic aneurysms and ectopic pregnancies, both of which I’ll address in the future.  The take home consideration here is to use these cues to know when to get rapidly evaluated.  Even though people use the Emergency Room for seemingly everything these days, knowing when time is of the essence for true emergencies is a life-saver.

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