Hi,

Thank you for your query.

I does appear that your sciatica symptoms are reappearing. Er are a number of actions you can take before seeking medical intervention.

Try to stay active if the pain allows. Bed rest may produce temporary relief but will not help in the long term. There are a number of stretching exercises that involve gently stretching the sciatic nerve and the hamstring muscles. It is also important to strengthen your core muscles and back muscles to improve the support of your back. A physiotherapist will be able to advise the most appropriate exercises. Also, swimming, walking and cycling on a static machine will help as these are low impact exercises. Endorphins are released as a result of exercise and these are natural pain killers.

Hot or cold compresses applied on the most painful areas may help.

Over the counter pain killers may help. Paracetamol would be appropriate to start with. I note you have a kidney problem therefore I would advise you avoid anti-inflammatories such as ibuprofen or diclofenac (Voltarol) unless you consult your doctor first. Your doctor may advise codeine or Tramadol. Also, diazepam, which has muscle relaxant properties, may be helpful. Again, you doctor would need to prescribe this.

Additional drugs which could be tried are amitripyline or gabapentin. Both these drugs are helpful in treating nerve pain.

Cognitive behavioural therapy (CBT) is a form of therapy whereby you are trained to think differently about pain and have a positive attitude and this leads to a reduction in the level of pain experienced.

These are management options which do not need significant medical intervention but would recommend you seek advice in the areas I have suggested.

Further to these options would be epidural injections and decompression surgery. Clearly, these are invasive procedures.

I hope this will help you with your symptoms. If you have any further questions, please do not hesitate to contact me.

Regards,
Dr K A Pottinger
MBChB FRCA

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