As discussed in the
Emergency Department prior to discharge, you have been diagnosed with
sciatica. Sciatica is a pain that comes from
the spine. The spine is made up of a
column of small bones (called “vertebrae”) that have spongey cushions stacked
between them, called “discs.” These
discs are cushions that act as shock absorbers for our spine. Sometimes these discs are injured and
protrude outwards. When discs protrude
outwards, they can push on nerves and cause pain. This pain moves along the pathway of the
nerve, and can be excruciating. If
sciatica is happening in your lower back, it is typical for the pain to shoot
down the back of your leg, along the path of the nerve.
For
most people, sciatica gets better within 4-6 weeks.
If
you were prescribed pain medication, take it as directed. If you are under the age of 70 and have no
kidney problems, this usually means starting with Ibuprofen (which is the same
thing as Advil or Motrin) or Acetaminophen (same thing as Tylenol, which is
safe in all age groups). You may have
been given a stronger pain medication, such as Hydrocodone (also known as Norco) or Oxycodone
(also known as Percocet). These stronger medications can make you
drowsy, so DO NOT DRIVE OR OPERATE HEAVY MACHINERY OR EQUIPMENT WITHIN 8
HOURS OF TAKING THESE MEDICATIONS. These medications usually also cause
constipation, so take an over-the-counter medicine for constipation, such as
Metamucil or Docusate, at the same time as taking these medications.
You may
also have been prescribed a muscle relaxant medication, such as Cyclobenzaprine
(also known as Flexeril) or Valium (also known as Diazepam). These medications work by decreasing muscle
spasm that often accompanies injury to a muscle in the back. It is important that you NOT DRIVE OR OPERATE
HEAVY MACHINERY OR EQUIPMENT WITHIN 8 HOURS OF TAKING THESE MEDICATIONS.
Complete
bedrest is no longer recommended.
However, do take it easy for a few days, and avoid all heavy lifting
(which includes lifting children). Don’t
sit for prolonged periods, because this actually increases the strain on your
back. When you are lying in bed, a firm
mattress is best. See if putting pillows
underneath your knees helps.
If
the pain persists for longer than a few weeks, talk to your primary care
provider about physical therapy and other adjunctive therapies.
Spine
surgery becomes an option if the pain continues for months. Given the high risks associated with
operating on the spine, most spine surgeons do not want to see patients until
they have experienced six months or more of daily pain.
https://www.acep.org/patient-care/smart-phrases/mri-for-low-back-pain/
Please note, it is no longer my personal practice to prescribe opioid pain medications in the treatment of back pain from musculoskeletal and atraumatic etiologies. I have included safety precautions in the discharge instructions for your review. As with all templates on this site, it is important that you review what is documented, and adapt it so as to keep in line with all appropriate practice recommendations relevant to the site where you work.
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