Question
I injured my spine 3 years ago and have since had 2 dysectomies at L5 S1. The problem I am still having is sever
right leg and foot pain. When I awoke from 2nd surgery 5 weeks ago the pain in my right foot was like walking on broken glass. My neurosurgeon is hopeful this pain will decrease but my recent MRI shows thickening of the sciatic nerve. What does this mean?Will this nerve ever repair itself? Or will this pain always be there? Is there specific Pain drugs for the nerve?I take 2x200mg tramal a day and have been for last 3 years as well as 5mg norspan patch.Do you have any ideas that may help my pain? Thanks
Julie  

Answer
Dear Julie,

Thickening of the sciatic nerve would be due to either inflammation inside the nerve itself or scar tissue build-up which is more likely.  All tissues heal with fibrotic repair or granulation scar tissue and this can be problematic in itself.  

Moreover, as the scar tissue grows, new nerve growth into the area will be pain fibers only and this compounds your pain experience.  This is called neo-neuralization, synaptic arborization, or wind-up depending on the nature of the nerve growth...The terms are all similar in nature but distinctly different in the technological descriptions.  I would suggest that you look them up on the Internet to get a better understanding.  Your doctors should be aware of these terms, their mechanisms of action considering pain transmission, and should be able to further discuss the implication for care.  I must say however, manipulation and mobilization of the spine has been found the most effective to break the pain cycle associated with these pain phenomenon.  If in the sciatic nerve itself, tissue mobilization such as stretching and deep tissue work is effective.

Now, that doesn't mean anything clinically unless the pain can be pinpointed to be occurring from the sciatic nerve.  With the symptoms you have described, the pain could be originating from the S1 nerve root at the spine, or the sciatic nerve.  A nerve conduction velocity test will help to determine the origin along with the MRI results.  This must be all be clinically correlated.

The Tramadol you are taking may or may not be helpful.  I have had many patients tell me that it doesn't help reduce their pain,  and have not been happy with the drug.  Everyone is different... pharmacological management will have varied results from patient to patient, and dose to dose...you must discuss this with the prescribing physician to pursue further options.

Bottom line:  did you have any physical therapy after the surgeries...if not you should have, and spine mobilization should have been part of the focus.  Chiropractic care would have been a good choice as it has been proven to affect change on the neurological impulses to the brain from inside the joint space and the nerves that connect to the disk...therefore reducing pain transmission.  Physical therapist are not specifically trained in this way, and are not allowed by law to perform these types of manipulations (spinal adjustments).  

I would further suggest that you seek out the care of a chiropractic physician who utilizes deep tissue techniques such as Graston, ART, or SASTM, while working with your current physicians on pharmacological management.  Additionally, a chiropractor who utilizes COX/ flexion-distraction would be of great benefit. Acupuncture is another avenue to explore for pain control...I have seen it work wonders on patients I co-treat with an acupuncturist.

Good Luck Julie!!

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net