DEAR DR. ROACH: I am wondering what the best treatment is for sciatic pain. Would a steroid shot help? The pain is behind my knee, down the outside of my leg, and now on my foot. — J.F.
ANSWER: “Sciatica” is a general term for a process that compresses the nerve roots, which causes symptoms such as pain, numbness, tingling, and a loss of reflexes. The sciatic nerve supplies much of the innervation to the leg. The area that you describe is most likely the first sacral nerve (S1), and pain here is most frequently caused by disc herniation at the L5-S1 space. This can cause acute symptoms that are often quite severe.
Initial treatment is usually conservative, consisting of antiinflammatories and avoiding activities that worsen pain. While bed rest was sometimes prescribed, it is seldom necessary for more than a day or two, and many people actually feel better when they are up and about. After a week, most people are able to do light activity, and I tell my patients neither to push themselves to do more than they can, nor force themselves to rest if they feel OK with light activity.
Steroids have certainly been used in this situation, and they are injected into the epidural space by an expert who uses imaging. Although there is a slight improvement in pain around three months among those who are treated with epidural steroids, there was no longer a benefit found around six months. This means that you get better only a little faster than normal at the cost of a small risk from the injection.
If a person isn’t recovering well within a few weeks, I often refer them to physical therapy. If they aren’t getting benefit at all (or they are getting worse), then it is time to find out what the cause is with an MRI and a referral to an expert.
Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible.
Readers may email questions to ToYour-GoodHealth@med. cornell.edu.