1 Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
2 Department of Anesthesiology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung
3Pain Clinic, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Sciatic pain is often caused by a lumbar herniated disc, degenerative disc disease or spinal stenosis. Typically, pain starts in the buttocks and runs down the back of the leg to the foot. It is often treated with medications (anti-inflammatory drugs, muscle relaxants, opioids, tricyclic antidepressants, or antiepileptic drugs), physical therapy, steroid injections and surgery. Herein we report a case of severe recurrent right sciatic pain in a 71-year-old man referred to our pain clinic The patient presented persistent pain (numeric rating scale 8/10) originating from the lower back running down into the right thigh and intermittent claudication. His otolaryngologist had prescribed him 20mg oxycodone per day. MRI of the lumbar spine revealed a grade 1 spondylolisthesis at L5-S1, degenerative disc disease at L5-S1 and herniated discs at L3-4, L4-5 and L5-S1. The patient received one caudal epidural steroid injection and was prescribed 10mg oxycodone per day. The patient’s pain intensity and life quality improved greatly during a 9 month follow- up period. Physicians may want to consider multimodal analgesia instead of opioids to resolve chronic sciatic pain in patients unwilling or unable to receive surgery.
sciatic pain, multimodal analgesia, epidural steroid injection, opioids.
Konstantinou K, Dunn KM:
Sciatica: review of epidemiological studies and prevalence estimates.
Spine 2008, 33(22):2464-2472.
Manchikanti L, Singh V, Kloth D, Slipman CW, Jasper JF, Trescot AM, Varley KG, Atluri SL, Giron C, Curran MJ et al
Interventional techniques in the management of chronic pain: Part 2.0.
Pain physician 2001, 4(1):24-96.
Singh V, Manchikanti L
Role of caudal epidural injections in the management of chronic low back pain.
Pain physician 2002, 5(2):133-148.
Doo AR, Kim JW, Lee JH, Han YJ, Son JS
A Comparison of Two Techniques for Ultrasound- guided Caudal Injection: The Influence of the Depth of the Inserted Needle on Caudal Block.
The Korean journal of pain 2015, 28(2):122-128.
Benditz A, Madl M, Loher M, Grifka J, Boluki D, Linhardt O
Prospective medium-term results of multimodal pain management in patients with lumbar radiculopathy.
Scientific Reports 2016, 6:28187.
Cherkin DC, Wheeler KJ, Barlow W, Deyo RA
Medication use for low back pain in primary care.
Spine 1998, 23(5):607-614.
Di Iorio D, Henley E, Doughty A
A survey of primary care physician practice patterns and adherence to acute low back problem guidelines.
Archives of family medicine 2000, 9(10):1015- 1021.
Martell BA, O'Connor PG, Kerns RD, Becker WC, Morales KH, Kosten TR, Fiellin DA
Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction.
Annals of internal medicine 2007, 146(2):116-127.
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.
The New England journal of medicine 2007, 356(22):2245-2256.