From the Guidelines
Sciatica pain is primarily caused by compression or irritation of the sciatic nerve, most commonly due to a herniated or slipped disc in the spine, as well as spinal stenosis, piriformis syndrome, and other conditions. The causes of sciatica pain can be multifaceted, involving various structures and conditions that affect the sciatic nerve. According to 1, a joint clinical practice guideline from the American College of Physicians and the American Pain Society, the evaluation of patients with persistent back and leg pain should consider the use of magnetic resonance imaging (MRI) or computed tomography (CT) to assess for conditions such as spinal stenosis or disc herniation.
Common Causes of Sciatica
- Herniated or slipped disc in the spine, where the soft inner material of a spinal disc protrudes and presses on nearby nerves 1
- Spinal stenosis, a narrowing of the spinal canal, which can compress the nerve roots that form the sciatic nerve
- Piriformis syndrome, occurring when the piriformis muscle in the buttock spasms and irritates the sciatic nerve
- Degenerative disc disease, spondylolisthesis, bone spurs, and injuries or trauma to the spine
- Pregnancy, due to pressure from the growing fetus on the sciatic nerve
Risk Factors
- Aging
- Obesity
- Occupations requiring heavy lifting or prolonged sitting
- Diabetes, which can increase nerve damage risk
Diagnosis and Treatment
Diagnosis involves a focused examination, including straight-leg-raise testing and a neurologic examination to assess the presence and severity of nerve root dysfunction 1. Treatment typically involves pain management with medications, physical therapy, and addressing the underlying cause through lifestyle modifications or, in severe cases, surgical intervention. It is essential to provide patients with evidence-based information on low back pain, advise them to remain active, and provide information about effective self-care options, as recommended by 1.