Chronic sciatica is a torturous and difficult to resolve back and leg pain syndrome. Sciatica is not a diagnosis, but a symptom of an underlying causative condition. True sciatica is sourced by a spinal abnormality, while pseudo-sciatica can come about due to muscular, circulatory or even psychosomatic reasons. No matter what the actual cause of sciatica, chronic symptoms can make life very difficult for affected patients.

Chronic means long lasting or recurring. For sciatica sufferers, there are a great number of different chronic patterns associated with their symptomatic expressions. Some patients endure the same pain everyday, while others endure a variable symptomology which can change hour to hour in some cases. Many patients endure constant back and leg pain, while others suffer only at certain times of the day, or with certain activities or positions. Some patients have a little or a lot of pain everyday, while others will have good days without pain and bad days with hellish symptoms. Finally, recurrent bouts of acute sciatica or “flare ups”, as they are often called, can be one of the most agonizing clinical profiles possible and can create a tremendous amount of anxiety in every sciatic nerve pain sufferer.

Statistically, the most common diagnostic conclusion used to explain sciatic nerve symptoms is a herniated lumbar disc, typically at L4/L5 or L5/S1. These are the levels which suffer the greatest and most universal degeneration in the human spine, so it is easy to see why herniations at these locations are common diagnostic scapegoats. However, in order for these bulging discs to enact symptoms, they would have to affect surrounding neurological tissues through the processes of spinal stenosis or foraminal stenosis. This is because the spinal discs themselves do not feel pain, as they do not have blood supply or nerve endings.

Foraminal stenosis is the usual diagnosis for herniated discs theorized to cause sciatica. These “pinched nerves”, as they are often called, go on to form the sciatic nerve, so it is thought that compression of one or more nerve roots can enact sciatica pain. Clinical research has decisively shown that actual compressed nerves stop signaling altogether, causing a condition of true objective numbness and weakness in the regions served by the affected nerve structure. There would be no lasting pain or tingling, as well as no subjective numbness and weakness common to the vast majority of sciatica complaints. This makes the pinched nerve theory lose tremendous credibility as a true source of sciatica. Additionally, in order for a herniated disc to actually have any effect on the nerve at all, the bulge would have to virtually completely close off the neuroforaminal space, which is a very rare scenario indeed.

Spinal stenosis as a source of sciatica is more complicated, since stenosis anywhere in the spine can create a variable pain pattern, along with the typical neurological symptoms in the legs. Stenosis in the lower back can create sciatica, as can stenosis far up in the cervical spine. This makes diagnosis very difficult, when the causation is indeed structural. Add to this fact that most stenosis is not symptomatic in anyway, even though anatomical alteration is evident upon diagnostic imaging, and you really have a hard time differentiating between potentially troublesome stenosis and innocent spinal canal narrowing. Many herniated discs, for example, may impinge on the thecal sac surrounding the spinal cord, but do not have any effect on the cord itself. Even herniations which do press into the cord typically may displace the cord (creating a frightening image on MRI films), but usually do not cause any pain or sciatica. However, in some cases, spinal stenosis can be problematic and truly enact lower back, buttocks and leg pain syndromes.

Despite all this doom and gloom, there is some good news about sciatica. Structural causations which are accurately diagnosed and truly do create symptoms most commonly respond very well to indicated medical and complementary treatment. This means that most true anatomical issues responsible for enacting pain can be completely cured. For patients with long term symptoms which have proven themselves to be unresponsive to various forms of treatment, the answer is simple. In these cases, the condition is virtually always misdiagnosed, leading the sufferer on a wild goose chase using treatments which are all targeting mistakenly identified causes of pain. No wonder the treatments fail…

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