The Bothersomeness of Sciatica

  I came across some a study, called the ‘Sciatica Bothersomeness Index’1, that evaluates how patients suffering from sciatica subjectively rate the ‘bothersomeness’ of various symptoms associated with the condition.

 My first thought was whether ‘bothersomeness’ is a real word. It is not to be found in any dictionary. My spell checker rejects it. Would it be acceptable to plunk that down on the Scrabble board?

Anyhow, sciatica is definitely not a joking matter. At any given point in time somewhere between 2 to 5% of the population suffers from the condition. It can be experienced as a single, brief episode, or as reoccurring incidents at varying intervals or a permanent affliction lasting months or years.

The sciatic nerve is the largest nerve in the human body – both the longest and widest. It is formed by nerve roots emanating out from both sides of the lower spine that bundle together into a single nerve that travels down the interior of the buttocks and leg to the foot supplying supplies nerves to the lower back and the entire leg. Portions of the nerve branch out into the thighs, calf, foot and toes.

The sciatic nerve is subject to being irritated or compressed when the structure of the lower back becomes compromised. About 90% of the time, it is due to a herniated disc that leaks outward from the core of the spine, pressing on and inflaming the nerve roots.

The condition that result are called ‘sciatica’ and are experienced as a group of symptoms – leg pain, numbness and/or tingling, and weakness – occurring in one or both legs that can range from mildly irritating to absolutely excruciating as well as incapacitating.

They most typically are felt down the back of the leg, but depending on which nerve roots are affected in what way, there can be a fair amount of variation. Sometimes it is felt only in the lower leg, sometimes it encompasses the entire leg, sometimes the buttocks or the feet are included, sometimes it felt more on the side of the leg.

Typical treatment options range from rest (‘conservative approach) to various forms of bodywork like physical therapy, chiropractic or osteopathic manipulation to acupuncture to drugs for pain management to surgery.

A less well-known modality is homeopathy, which can be quite effective and fast acting in many cases. This may seem counterintuitive at first glance because sciatica appears to be largely a structural issue, but the remedies act to stimulate an internal energetic shift that can reduces inflammation and promotes structural realignment.

Beliefs and theoretical explanations aside, the proof is in the pudding…

A few weeks ago a call came into the office from a patient whose wife was in the grips of a bad case of sciatica. He was hoping I could prescribe a remedy by speaking with his wife over the phone since they lived about five hours away.

It was evening by the time I could get back to her. We had never met before, but there was no time to do a full medical history or the typical comprehensive intake I usually do for an initial appointment.   So, I focused on the symptoms and origins of the issue at hand.

Diana, or so we will call her, is a 60 year old woman in good health. Three weeks earlier she had strained her back and self treated with unspecified remedies.   The back responded well, but the next day there was pain extending from her right hip down the side of her leg into the ankle.   She had tried to address it with a few homeopathic remedies suggested by her husband and brother-in-law, but improvement had only been incomplete and temporary at that.

Selecting an effective homeopathic remedy is a bit like attending a Passover service. For the uninitiated, the most widely recognized part of the service is the first of four questions: why is this night different than all other nights? The most important question one needs to address in any homeopathic intake is how is this person or this disease or this group of symptoms different from all others?

We call those differences the characteristics of the case – the thing or things that make it distinct or unusual. (‘Strange, rare and peculiar’ in homeopathic lingo.)

Asking further about the details of Diana’s symptoms, she told me that the pain was intermittent but largely better during the day. It was at night, an hour after lying down, especially after midnight, that the pain became quite excruciating. She wasn’t sleeping but a few hours every night and was at her wits end. If the remedy I suggested didn’t work, she was ready for a trip to the ER and some steroids…

In the homeopathic repertory, the exhaustive database of symptoms along with the remedies relating to those symptoms that assists homeopaths to differentiate and ultimately select the most appropriate medicine, there are a lot of remedies listed under ‘sciatic pain’. To be precise, in the most current computerized version I consulted, there are 284 remedies from which to make a single choice.

The information that Diana related so far had been helpful. The ‘modalities’ – those factors that make the condition better or worse – she had given such as right sided, aggravated by lying down, worse at night and better during the day all had narrowed the possibilities to a great extent, but I needed press her further for still more in order to arrive at that single remedy, the ‘simillimum’, which I could prescribe confidently.

There wasn’t much more Diana could tell me about her sciatica, so I asked to think of anything else she could tell me about how she was feeling since the onset of the condition.   She thought for a moment and answered, ‘Well, my feet are get cold when I lie down to sleep. That has never happened to me before.’

That sounded like a bit peculiar. The sciatica was one sided, but both feet were going cold. So, I looked at the repertory and found a single rubric (symptom) listed in the extremities section: Coldness in the feet aggravated by lying down. Out of thousands of possible remedies, there was only one remedy listed and it was one of the ones on my short list. Bingo.

The substance tellurium is a metal, nestled in the fifth row of the periodic table between antimony and iodine. It is a fairly well known homeopathic remedy, its curative properties having been researched by the ‘father of American homeopathy’ Constantine Hering over 150 years ago. But it is most well known for its affinity for the back and the spinal column.

Following the selection of the remedy, the problem remained as to how to get it to Diana promptly.   It is the type of remedy readily available at a health food store and it took several days to reach her. In the meantime, she had reached her wits end and submitted to a steroid injection, which worked for a few hours only.

Fortunately, when the remedy reached her and she began taking it she started to feel better from that evening. A few weeks later, I was able to follow up with Diana in person and she reported that the sciatica was 99% better.