People suffering from sciatica often ask Andrew So, MD, a board-certified anesthesiologist and interventional pain management physician with Garden State Pain & Orthopedics, “Is this what my life is going to be like from now on?”
“Sciatica can cause significant pain in the lower back, buttocks and an affected leg, as well as sensations of numbness, burning, heaviness, pins-and-needle tingling and even of an electric jolt running down the leg,” noted Dr. So, who sees patients in Garden State Pain & Orthopedics’s Edison, Clifton, Hazlet and Jersey City offices. “Those physical symptoms can be debilitating in their own right, but they also can give rise to considerable anxiety and stress, which is why people understandably are concerned about what the future may hold for them.
“Fortunately, we have more options than ever to treat sciatica effectively,” the physician added, “enabling us to individualize treatment plans based on each patient’s specific condition and needs, and to provide the great majority of people with relief from their pain and other symptoms.”
Dr. So offered his thoughts on causes of sciatica, risk factors for the condition, and how he and his Garden State Pain & Orthopedics colleagues diagnose it and take a comprehensive, multimodal and patient-centric approach to treatment.
“The sciatic nerve is the longest and thickest nerve in the body. It originates in the lower back and then branches through the hips and buttocks to run down each leg,” Dr. So explained. “Five nerve roots in the lower back come together at the point where the sciatic nerve begins. In common parlance, any trauma or injury to the sciatic nerve itself, or to one or more of those five nerve roots, is termed sciatica.”
The most frequent cause of sciatica is a herniated disc that compresses or irritates a nerve in the lower back, the physician noted, adding, “Other frequent causes include a narrowing of the spine — called stenosis in medical terms — and a misalignment of the spine. In rare cases, a tumor will cause sciatica by pressing on a nerve.”
Annually, between 1% and 5% of U.S. adults experience sciatica, Dr. So said. “The condition does not seem to be more common in men than women, but there is an age-related component. It is rare to see sciatica in people before age 20, unless they have experienced some trauma, such as a car accident; while the peak occurrence is in the fourth decade of life.” People whose work involves heavy physical labor or awkward or repetitive motions are at increased risk for sciatica, as are people who are significantly overweight, because excess pounds place increased pressure on the spine, the pain-management specialist said. Sciatica isn’t a threat just for longshoremen handling cargo or for professional movers carrying furniture. “A parent who picks up a young child at an awkward angle also can experience a disc herniation and sciatica,” the physician noted.
Identifying the Cause of Sciatica Symptoms
Individuals experiencing symptoms of sciatica should see a physician sooner rather than later, Dr. So said, noting, “Living with pain for an extended period without seeking care does no good, and actually may be harmful by enabling a condition to become worse and thus more difficult to treat effectively by conservative means.”
Some sciatica sufferers put off being evaluated by a doctor because they are concerned that they will be told that they need surgery or a prescription for narcotics, the pain management specialist said. “In reality, nonsurgical interventions are effective for most patients, and narcotics generally are not used for pain control in sciatica. We have several other good options to offer our patients, who we always involve in shared decision-making about which approach is best for them,” he said. “The unfortunate irony is that by waiting too long to seek care, a patient sometimes can increase the likelihood that surgery may be needed because his or her condition has deteriorated past the point where it would have responded to other, less-involved treatments.”
When patients consult Dr. So for symptoms of sciatica, his evaluation includes a thorough history, a musculoskeletal examination and a neurological examination, along with any other assessments indicated by the patient’s specific condition. “It’s important to take a detailed medical history to determine whether anything from past years could be contributing to the current problem, and also to identify any red flags for rare but very serious conditions that could be causing the symptoms and that require immediate intervention,” the doctor explained. “For example, when symptoms of sciatica are accompanied by recent problems with urinary incontinence or retention, we would want to rule out cauda equina syndrome, an uncommon condition that can lead to paralysis without surgical intervention. However, the overwhelming majority of people who present with symptoms of sciatica have less problematic and more manageable conditions, such as a herniated disc.”
Imaging studies also factor into the evaluation, with their timing and the choice of modality dependent on the initial history and physical, Dr. So added. When the diagnosis is clear-cut based on clinical signs and symptoms, imaging sometimes can be deferred in favor of several weeks of conservative management. In other cases, an X-ray and/or magnetic resonance imaging (MRI) is indicated at the outset to help confirm the clinical diagnosis and inform treatment plans. “An MRI can be particularly helpful because it gives us considerable information on the disc and nerves involved,” the physician said. The Garden State Pain Control team also can perform electromyography (EMG) and other complex diagnostic assessments when necessary.
Education also is a key element of every patient visit at Garden State Pain & Orthopedics, starting with the first evaluation, Dr. So said. “We tailor the education to the patient’s lifestyle and needs. For instance, going back to the example of a parent who frequently needs to pick up and carry a toddler, we’ll focus on proper techniques to avoid muscle strains and other problems. We also talk about maintaining good posture and increasing core strength, both of which are important for back health,” said the physician, who received the Leo M. Davidoff Society Outstanding Teacher Award from his peers and faculty during his residency in anesthesiology at Albert Einstein University of Medicine/Montefiore Medical Center.
An Array of Treatment Options
Once the diagnosis of sciatica has been confirmed and the underlying problem identified, most patients obtain relief from four to six weeks of conservative management, which consists of applying hot and cold packs, avoiding prolonged sitting, engaging in light exercise such as walking or swimming, practicing good posture and, often, physical therapy, Dr. So said. “There used to be a school of thought that bed rest was helpful for sciatica, but we’ve since learned that being immobile for prolonged periods does not help and actually may make symptoms worse,” the pain-management expert said of a misconception he often faces.
When conservative management doesn’t resolve symptoms or adequately ease them, several nonsurgical choices are available, Dr. So said. “Depending on the location of the nerve compression, we can consider an epidural injection. We also can use a number of medications, including anti-inflammatories, muscle relaxants and agents that treat neuropathic pain. Again, narcotics typically are not among the medications we would consider. At Garden State Pain & Orthopedics, we also offer appropriately selected patients the option of a spinal cord stimulation device, an implanted technology that essentially blocks the nerve signals that cause pain and other symptoms. This can be an excellent choice for patients who really are resistant to the idea of spinal surgery or who may not be good candidates for the surgery because of their overall health. Finally, when warranted, there also are a number of surgical approaches — including minimally invasive procedures — that can provide lasting relief,” the physician said.
The medical staff at Garden State Pain & Orthopedics includes pain-management specialists, physical medicine and rehabilitation physicians, sports medicine physicians, anesthesiologists and an orthopedic surgeon, allowing the practice to draw on a broad spectrum of expertise and experience in formulating an individualized care plan for each patient, Dr. So said.
“Pain is a multifactorial issue, and taking a multimodal approach when necessary allows us to provide the patient with a number of options and then work with him or her to select the one that offers the best outcomes for his or her specific situation and that best aligns with the patient’s preferences and goals,” the doctor said.
Dr. So attended the University of Michigan, where he graduated as an Angel Scholar with a bachelor of science degree in brain behavior and cognitive sciences. He received a Doctor of Medicine degree from Virginia Commonwealth University, where he was a distinguished merit scholar and was voted class president by his peers. He completed a residency in anesthesiology at Albert Einstein University of Medicine/Montefiore Medical Center. Following residency, Dr. So completed fellowship training at Albert Einstein University of Medicine/Montefiore Medical Center, specializing in interventional pain management. In addition to his extensive training, Dr. So has contributed to the field of pain management through research initiatives and various publications, as well as presentations at national and regional conferences.
Dr. So’s specialties include neck, back, spine, headache, migraine, joint, knee, shoulder and hip pain; post-laminectomy syndrome; neuropathy, acute; post-surgical pain syndromes; and complex regional pain syndrome (CRPS), among others.
Dr. So and his Garden State Pain & Orthopedics colleagues see patients at the practice’s offices in Clifton, (973) 291-2057, Edison, (732) 256-2927; Hazlet, (732) 256-8088; and Jersey City, (973) 291-2466. For more information, or to schedule an appointment, call the Garden State Pain & Orthopedics office closest to you or visit gardenstatepain.com.