Sciatica

How nerve pain feels

The pain may be burning, stabbing or like an electric shock, often from the buttocks toward the back or side of the leg. It may reach the foot and toes. Pins and needles, numbness or weakness help assess nerve involvement. Lower back pain may be mild or absent.

The doctor distinguishes radicular pain from radiculopathy, in which there are also objective signs such as reduced strength, sensation or reflexes. This distinction affects how quickly investigation is needed. The intensity of pain alone does not show whether a nerve is losing function.

Signs that must not wait

A new inability to lift the foot, or a gait that changes because of weakness, requires prompt assessment. Pain with fever, trauma, a history of tumor or weight loss should not be treated as ordinary sciatica without a consultation.

What the examination involves

The doctor asks about spread, onset and the factors that increase the pain. They assess strength, sensation, reflexes and the tests that put tension on the nerve root. They also examine the hip joint and other causes, because referred pain from muscles or joints can resemble sciatica.

MRI is not automatically requested in every early episode without warning signs. It is recommended when the findings could change treatment or when a serious condition is suspected. A changed disc on imaging must match the symptoms; the decision is not made from the words in a report alone.

Activity and physiotherapy

Many episodes improve over weeks or months, although the course varies and relapses may occur. Keep up tolerable activity and avoid prolonged bed rest. Spread walking and chores over intervals you can manage.

Physiotherapy may include adapted exercises and a gradual return of physical capacity. An exercise that helps one person may increase another’s symptoms. Stop and seek advice if new weakness appears or numbness clearly spreads. Progress is assessed also by sleep, walking and ability to work.

Medicines and further treatments

The benefit of medicines varies and must be weighed against the risk to the stomach, kidneys and heart and against interactions. According to NICE, gabapentinoids, benzodiazepines and oral corticosteroids are not recommended routinely for sciatica. Opioids are not recommended for chronic sciatica. If you have been taking them for some time, do not stop abruptly; ask for a controlled review.

In selected cases an epidural injection or a surgical intervention may be discussed. Surgery is considered particularly when non-surgical treatment has not improved pain or function and the imaging matches the symptoms.

Frequently asked questions

How long does sciatica last? Many episodes improve within a few weeks, but some last months and relapses may occur. The duration depends on the cause, the level of nerve involvement and the activity maintained. Lack of improvement after a few weeks or the appearance of weakness is a reason for reassessment.

Does heat or cold help? Local heat or cold may bring temporary relief of comfort, with protection of the skin from burns or chilling. It does not treat the cause, so it is used as an aid and not as a substitute for activity and an assessed plan.

Is it safe to use painkillers for a long time? Prolonged use requires assessment, because medicines may burden the stomach, kidneys and heart and interact with other treatments. Do not stop abruptly medicines you have taken for a long time and do not combine preparations without asking. The doctor weighs benefit against risk for each patient.

Does it matter if the pain is in both legs? Yes. Pain or weakness in both legs, especially with numbness around the anus or a change in urination, may indicate significant nerve compression and requires urgent assessment. Ordinary sciatica more often affects one leg.

What to report during follow-up

Tell the doctor whether the pain is becoming more bearable and whether you can walk, sleep or work better. Report numbness and weakness separately. A person may still have pain while function is returning; another may have little pain but a loss of strength that requires faster investigation.

Note which medicines you have tried, for how long and whether they caused side effects. This avoids repeating treatments without benefit. If the pain returns, a new examination helps determine whether it is the same pattern or a different problem. An old MRI does not replace assessment of a new weakness, and a familiar episode does not automatically explain all future symptoms.

Care at Tirana Polyclinic: We offer specialist assessment, interpretation of imaging performed at other centers and coordination with physiotherapy. If there are emergency signs or an indication for surgery, referral is made to the relevant service.