Sciatica: Ordinary Painkillers Ineffective — Electric Stimulation and Injections Strike at the Root of the Pain

Article Date：18 April 2016

[Ming Pao Special Report] Lower back pain is the most stubborn kind, especially sciatica that radiates down to the calf or ankle. Painkillers, physiotherapy, and even surgery have all been tried, yet the pain remains. What can be done?

When sciatica is mentioned, many people think only of orthopedic surgeons and physiotherapists. But there is actually another specialty — the pain medicine specialist — who can also contribute to pain relief.

In dealing with sciatica, when conservative treatments such as painkillers and physiotherapy fail, doctors and patients have to consider surgery. Now there is also the option of interventional treatment.

Drugs Injected into the Lumbar Joints

“Interventional treatment sits between conservative treatment and surgery, and is less invasive than surgery.” Dr. Lee Yuk-ming, a specialist in pain medicine, points out that interventional treatment uses various methods to help patients control pain, and can be used before or after surgery. The simplest is the injection method, along with radiofrequency therapy and spinal cord stimulation.

“An ordinary painkiller injection delivers the drug into the muscle, where it enters the bloodstream and takes effect. The injection method in interventional treatment, by contrast, injects directly at the site of the pain.” Using sciatica as an example, he explains that interventional treatment uses imaging such as ultrasound, X-ray, or CT scan to inject medication into the lumbar joints, allowing the drug to penetrate the nerve and achieve the effect of reducing inflammation and relieving pain.

For sciatica caused by a herniated disc, about 80 percent of patients find their pain subsides within six weeks. The doctor’s responsibility is to help patients reduce pain during those six weeks. When ordinary painkillers and physiotherapy fail, the simple interventional treatment described above can be considered.

“However, if the patient’s pain persists after treatment, surgery to remove the herniated disc must be considered. Yet of these, 10 to 40 percent of patients still do not get relief after surgery, and then some more complex interventional treatments have to be considered.” Dr. Lee explains that one reason pain does not subside after surgery is that the surgical scar pulls on the nerve and produces pain. Even if surgery is repeated, wounds and scars will still form, which does not help relieve the pain.

Subcutaneous Electrode Wire — Electrically “Zapping” Away the Pain

In this situation, spinal cord stimulation should be considered. “It is similar to a pacemaker: a wire is placed at the painful site on the spinal nerve, connected to a current generator implanted under the skin, which emits an electrical current to alter the sensation of pain.”

There is also radiofrequency therapy, commonly used for fake sciatica, where the pain is located in the small (facet) joints of the spine rather than the spinal joints. “A nerve is like an electrical wire, with a layer of material wrapped around its surface. Radiofrequency therapy

文：鄭寶華、陳雅君

圖：馮凱鍵、Eraxion@iStockphoto

編輯：王翠麗

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