While there is no doubt that patient’s education is key in any treatment, proper and knowledgeable education is often missed when it comes to sciatica. This leaves the patients worried and frustrated and thinking they have weak low backs and damaged discs.

If you want to learn more about this topic, you can watch Tom Jesson’s lecture here:

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Here are some tips for educating patients about sciatica:

1. Acknowledge and validate your patient’s symptoms

Radicular pain can be unbelievably painful and excruciating, that many women report its pain being worse than childbirth. Here are some quotations from people with sciatica:

‘ … it was absolutely excruciating. I felt like ten knives were being rammed into my body. It was horrendous. It took me completely by surprise.’ [2]

‘I don’t think it’s taken seriously enough. I don’t think people realize how painful it is. It’s excruciating. Constant.’ [2]

Acknowledge your patient’s pain and explain that it’s not necessarily a sign there’s a more serious problem. Reassure your patient’s that the pain is worst on the early days and usually improves in the first few weeks. So just stay quiet and listen to your patients. Tell them that you understand how painful it can be and that it gets better.

2. Discs can resolve on their own

Roughly, up to 60% of spinal discs herniations resolve on their own. Not only do many lumbar herniations resolve but the worse the herniation the more likely it is to regress. This systematic review of 31 studies revealed a strong pattern of better regression from the worst cases: “Patients with disc extrusion and sequestration had a significantly higher possibility of having spontaneous regression than did those with bulging or protruding discs.” [3]

This little piece of information very often fills patients with relief, especially for patients with big disc herniations demonstrated on their MRIs.

3. The 2 step explanation process

Sciatica involves more than just mechanical compression, as not only does the disc press on the nerve root, but the disc material itself contain chemical irritants that spill onto the nerve root leading to chemical irritation and an inflammatory response.

Many people with sciatica have half an understanding of radicular pain, as the “mechanical pressure” half is often explained to them through their MRI or using spinal models. While the other half, the “chemical irritation” is often overlooked.

As demonstrated by this patient’s quotation:

‘the ibuprofen was never going to work on a bit of my disc protruding into that area… don’t put a plaster on it, just get in and sort this.’ [2]

A nice way to educate your patient is through the 2 step explanation process. The first step is the part most people know, the “mechanical pressure”. The next step is the “chemical irritation”. Explaining that not only is your nerve being pressed on but it also became irritated or inflamed…etc.

You can communicate this to your patient using your own words to explain that not only is their nerve “crowded” or “squashed” or “pressed on”, it is also “inflamed” “irritated” “pissed off”.

This helps your patients understand how physical activity, sleep and stress management can play a role in their recovery. As it helps manages the inflamed or irritated nerve and soothes it down.

4. Explain all the options to your patients and be realistic:

As mentioned above, radicular pain can be extremely painful. So it is important to remember that there are other options for people with radicular pain that should not be overlooked and patients should be educated about them. Other options include surgery, injections and drugs.

There seems to be a slight benefit from getting surgery sooner rather than later, people who have surgery within the first 6 months of their pain have slightly better outcomes. So it may be a little better to not wait too long before referring to surgery. [4]

The evidence is messy when it comes to injections. However, similar to surgery, injections are best done early before progressive nerve damage has set in.

For drugs, there is no evidence for gabapentinoids or oral steroids despite anecdotal reports that they both work. It is a matter of hit and miss but it's good to have a variety of options.

So to sum it all up:

• Reassure your patients and validate their symptoms

• The bigger the disc herniation, the more likely it is to resolve on its own

• Sciatica involves both mechanical pressure and chemical irritation

• Keep an open mind to other options

If you want to learn more about this topic, you can watch Tom Jesson’s lecture here:

Click here

Sources:

1. Lecture ‘Sciatica‘ by Tom Jesson

2. Goldsmith R, Williams NH, Wood F. Understanding sciatica: illness and treatment beliefs in a lumbar radicular pain population. A qualitative interview study. BJGP Open 2019; 3. doi: doi: 10.3399/bjgpopen19X101654.[Epub ahead of print: 29 Oct 2019].

3. Zhong M, Jin-Tao L, Jiang H, Wen M, Peng-Fei Y, Xiao-Chun L, Xue RR. Incidence of spontaneous resorption of lumbar disc herniation: a meta-analysis. Pain physician. 2017;20(1):E45.

4. Peul WC, Van Houwelingen HC, van den Hout WB, Brand R, Eekhof JA, Tans JT, Thomeer RT, Koes BW. Surgery versus prolonged conservative treatment for sciatica. New England Journal of Medicine. 2007 May 31;356(22):2245-56.