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Primary Care Management of Sciatica. Manoj Krishna Spinal Surgeon www.spinalsurgeon.com. Evaluation. Rule out Cauda Equina Syndrome Any bladder function change? Any Peri -anal altered sensation? Bilateral Leg pain? Check pulses, hips and abdomen
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Primary Care Management of Sciatica Manoj Krishna Spinal Surgeon www.spinalsurgeon.com
Evaluation • Rule out CaudaEquina Syndrome • Any bladder function change? • Any Peri-anal altered sensation? • Bilateral Leg pain? • Check pulses, hips and abdomen • Is Neurology progressive ?( Urgent referral) • Could it be non-spinal ?
Analgesia( Pain can be severe) • Consider Morphine. MST 20mg BD and Oromorph 10mg 6hourly for breakthrough pain. Continue till acute pain eases( 2-4 weeks) and then switch to Tramadol or Codeine. • Paracetamol and Naproxen • Gabapentin or Pregabalin • Diazapam in small doses for muscle spasm
Physical Therapy • Refer early to Physiotherapy/Osteopath/Chiropractor • Monitor progress • If not improving at 6 weeks consider a referral to a spinal surgeon for consideration for an epidural injection/nerve root block- gives almost instant relief of pain for 6-12 weeks
Indications for referral and surgery • Suspected CaudaEquina syndrome and progressive neurodeficit • Diagnosis uncertain • Pain not settling by 6-8 weeks • Pain severe, disabling and not responding to analgesia • Patient who needs to return to work quickly and cannot afford to wait
