Last updated date: 18-Nov-2021
13 mins read
Neurological pain is definitely one of the most agonizing pain a patient could ever experience.
It is also called neuropathic pain. But what is neuropathic pain? It is a condition that happens when the nervous system is damaged or not working correctly.
This type of pain, neuropathic pain, can emerge from any level of the nervous system, the peripheral nerves, the spinal cord or the brain.
The nervous system is your body’s command system. It guides almost everything you do, say or feel. It controls complicated processes like movement, thought and memory. It also controls some functions your body does without thinking such as breathing and blinking.
This complex system is the command system of your body because it affects every aspect of your health including:
- Movements, balance and coordination.
- Thought and memory.
- Learning new skills.
- Senses and interpretation of what you hear, see or taste.
- Heartbeat and breathing patterns.
- Responses to stressful situations.
- Body processes such as puberty.
- Digestion and thirst.
So, in conclusion, the nervous system regulates the body’s systems and allows the human being to experience the environment.
But how does that happen? How does the nervous system work?
The nervous system consists of a vast network of nerves. Those nerves send electrical signals to and from other cells, muscles and glands all the time and all over the body.
Those nerves also receive the variant information you get from the world all day long and interpret it to control your responses to the different situations that happen around you.
The nervous system can do all these functions without us even noticing by using a specialized type of cells called neurons. These neurons help deliver an enormous number of signals from the brain to different organs and vice versa.
These messages are the core of how the nervous system works. They help you move your limbs or feel different sensations such as pain and temperature.
However, not all neurons work the same way. In fact, there are different types of neurons. Every type sends different signals, for instance, motor neurons tell muscles to move, while sensory neurons take information from the senses and send signals to the brain. There is another type of neuron that controls the things your body does automatically such as breathing, blinking and having a regular heartbeat.
The nervous system has two main parts. Those two parts are:
- The central nervous system (CNS). It consists of the brain and the spinal cord. The brain uses the vast network of neurons we talked about to send signals to all the body parts all the time. Each neuron has an outer protective layer called myelin. Myelin insulates the nerves and helps to deliver the messages.
- The peripheral nervous system (PNS). It consists of numerous nerves that branch out of the central nervous system. This system' function mainly is to deliver messages from the brain and spinal cord to all body parts. The peripheral nervous system contains the somatic nervous system, which controls the voluntary movements, and the autonomic nervous system, which controls the involuntary functions or the functions your body does without you thinking about them.
Thousands of conditions and diseases can affect the nervous system. For instance, any injury in the nerves can affect the process of sending a message.
And as we mentioned at the beginning of our article, neuropathic pain is one of these conditions.
Nerve damage can happen due to other reasons, including:
- Diseases. Autoimmune diseases such as lupus, diabetes and rheumatoid arthritis, cancer and some infections can affect the nervous system severely. For instance, diabetes can attack the peripheral nerves causing what's known as peripheral neuropathy. It manifests as pain and tingling in the legs or feet. Another condition known as multiple sclerosis affects the nerves by attacking the protective layer around the nerves in the CNS, the myelin sheath.
- Strokes. A stroke happens when there is not enough blood supply going to the brain. Low blood supply will eventually lead to the death of a part of the brain. This dead part won't send messages to nerves anymore. A stroke can also cause nerve damage ranging from mild nerve damage to severe nerve damage.
- Accidental injuries. Accidents are so common and they can affect nerves as well as other body parts. Nerves can be cut, crushed or stretched in an accident, especially in car crashes or falls.
- Toxic substances. Excessive alcohol, chemotherapy and illegal drugs can cause peripheral neuropathy or complete nerve damage. People with kidney diseases are more likely to get this type of nerve damage because their kidneys can no longer filter toxic substances.
- Pressure. When a nerve is compressed, it doesn't get enough blood to do its function. Nerves can get trapped for many reasons such as overuse as in carpal tunnel syndrome or they can get pinched by a tumor or structural problems like sciatica.
- Ageing process. As we get old, our neurons may not work as efficiently as before, they get weaker and the reflexes slow down. Some people may even lose sensation in a specific part of their body.
Some of the causes of nerve pain are more frequent than others. For instance, diabetes is an endocrine disorder that causes peripheral neuropathy. About 30% of all nerve pain happens because of diabetes.
But diabetes is not the main focus of this article.
We will focus on sciatica. We mentioned sciatica as a cause of neuropathic pain.
But what is sciatica?
Sciatica is nerve pain from an injury or irritation to the sciatic nerve.
The sciatic nerve originates from the buttock/gluteal region.
It is the longest and thickest nerve in the body, it is almost a finger-width.
The reason it is so thick is that it is made up of five nerve roots: two nerve roots from the lower back region, called the lumbar spine, and three from the last region of the spine called the sacrum.
All the five roots come together to form the right and left sciatic nerve on each side of the body.
The sciatic nerve, as we mentioned, originates in the gluteal region as it runs through the hips, buttocks and down the leg to end just below the knee. Under the knee, the sciatic nerve branches into other smaller nerves. Those small nerves continue down the rest of the leg and into the foot and toes.
The term "sciatica" is not usually used to describe a true injury to the sciatic nerve, because the actual injury is somewhat rare.
Instead, the term is commonly used to describe any neuropathic pain that starts in the lower back and radiates down the leg and foot.
So, what does sciatica pain feel like?
Patients who have sciatica will experience mild to severe pain anywhere along the path of the sciatica nerve. So, they will experience pain anywhere from the lower back through the hips or down to the legs.
Patients usually describe sciatica pain differently according to its cause. Some patients describe it as sharp, shooting or jolts of pain, while others describe it as burning, electric, or stabbing pain.
The duration of the pain is also different from one patient to another. The pain may remain in some patients constantly while it may come and go in other patients.
The pain is also reported to be more severe in the legs than in the lower back. It may also feel worse if you sit or stand for long periods of time. Some sudden body movements may also make the pain worse like coughing, sneezing, or suddenly twisting the upper body.
What are the symptoms of sciatica?
From the previous explanation of the pain of sciatica, we can now sum up the symptoms of sciatica in a few points.
Symptoms of sciatica include:
- One of the hallmark symptoms of sciatica is the pain that starts in the lower back\ spine and radiates to the buttocks and down the back of the legs.
- Discomfort or pain almost anywhere along the course of the nerve but it is more likely to follow the path from the lower back to the buttocks and the back of the thighs and calf.
- Pain that varies from very mild to a sharp burning sensation.
- Pain that sometimes feels like a jolt or an electric shock.
- Pain that gets worse with prolonged sitting or standing.
- One side of the body is usually affected.
- Some patients reported having numbness, tingling, and muscle weakness in the affected leg or foot.
- Pain might be in one part of the affected leg and numbness in another part.
So, we just mentioned that one leg is usually affected.
But can sciatica occur down both legs?
It is more commonly known that sciatica affects one leg at a time. However, sciatica can occur down both legs. It depends on the location where the nerve gets pinched or compressed along the spinal column.
In addition, in general, sciatica can occur suddenly or gradually. It all depends on the cause of the nerve compression. For example, a disk herniation can cause sudden pain, while arthritis in the spine develops gradually over time and, consequently, pain develops slowly over time.
A question we get a lot about sciatica is, is sciatica that common?
Yes, it is.
Sciatica is a very common complaint.
Back pain is the third most common reason people visit their healthcare providers.
But what causes sciatica?
As we explained, the whole process starts when the sciatic nerve gets pinched out or compressed anywhere along its course by a herniated disk or overgrowth of bones. More rarely, the nerve gets compressed by a tumor or gets damaged by diabetes.
Let’s have a look at some of the several medical conditions that cause sciatica:
- A herniated or slipped disk. This is considered the most common cause of sciatica. When it happens, it causes pressure on the nerve roots of the sciatica nerve. Intervertebral disks are like cushioning pads between the vertebrae of the spine. Each disk has a gel-like substance in the center. Pressure can cause this gel-like substance to bulge through a weak point in the wall of the disk. When this happens, it can compress the sciatica nerve.
- Degenerative disk diseases. It is a natural process of wearing down the disks between the vertebrae and shortening their height. This can lead to narrowing down the pass way of the nerve.
- Spinal stenosis. It is a condition of an abnormal narrowing of the spinal canal. This narrowing reduces the available space of the spinal cord and other nerves.
In addition, scientists have identified some risk factors that make people at a greater risk for developing sciatica pain, including:
- Age. Age-related changes such as herniated disks and spurs are considered the most common causes of sciatica. Normal ageing includes wearing down of the bones and discs in the spine. So, nerves can get pinched or compressed easily with all these changes.
- Having a current or previous injury. Any injury in the lower back or the spine puts you at a greater risk for developing sciatica.
- Obesity. Excess body weight can put more stress on the spine and contribute to spinal changes that lead to sciatica eventually. The spine is more like a vertical crane. The weights we carry in the front of the body is what the spine has to deal with. Muscles usually work as counterweights. The more weight you have at the front, the more the muscles have to work, which will lead to back strain and pain.
- Lacking a strong core. The definition of the core is the muscles of the back and abdomen. The stronger the core, the more support to the lower back. Have in mind that, unlike the chest area where ribs provide support, the only support for the lower back is the muscles.
- Occupational causes. Having an active physical job that requires lifting heavy weights, twisting the upper body, or driving motor vehicles for long periods can increase your risk of lower back problems in general and getting sciatica in particular. However, there is no conclusive evidence of this relation.
- Prolonged sitting. People who sit for prolonged times or have a sedentary lifestyle can develop sciatica more than active people. It is really important to exercise and keep your muscles moving and toned.
- Having diabetes. Diabetes increases the chances of nerve damage and causes peripheral neuropathy, which increases the chances of getting sciatica.
- Smoking. Nicotine is known to weaken bones and damage the spinal tissue, and so it can lead to wearing down the disks and causing sciatica eventually.
One of the risk factors we mentioned was obesity and excess weight on the spine.
But does pregnancy count?
So many pregnant women develop sciatica.
Is the weight of pregnancy the reason why so many pregnant women get sciatica?
It is very common and true that many pregnant women get sciatica, but increased weight during pregnancy is not the main reason pregnant women get sciatica.
The true reason behind this phenomenon is that hormones of pregnancy cause loosening of the ligaments. Ligaments are responsible for holding the spine together, keeping stability, and protecting the disks.
Loosening of the ligaments during pregnancy may cause the spine to become unstable and cause disks to slip. This way some nerves will be pinched and sciatica may develop. The baby’s weight and position can play a role in the development of sciatica as well.
But what happens after labor? Do women have to suffer from sciatica pain even after labor?
The good news is that there are some ways to ease sciatica pain during pregnancy, and the pain will go away after birth either way.
Massage therapy, physical therapy, heat medications and warm showers can help if you are pregnant and have sciatica pain.
But all in all, pregnant women have to follow good posture instructions to avoid getting sciatica and other lower back problems.
If lower back pain and other leg problems are so common, how is sciatica differentiated from other conditions?
How is sciatica diagnosed?
When a patient complains of low back pain or leg pain, the first thing the health care provider does is to review the medical history of the patient and ask more about the symptoms.
The health care provider will also ask the patient to walk so he or she can see how the spine carries the body weight.
Other physical tests will be included in the examination, including:
- Walking on the heels or toes to check the strength of the calf muscles.
- Straight leg raise test. The health care provider will ask the patient to lie on their back with straight legs. The health care provider will slowly raise each leg and note the point at which the pain begins. This test is highly beneficial because it helps to pinpoint the affected nerve and determine if there is a problem with one of the vertebral disks.
- Other stretches and motions will be required to pinpoint the pain and check the flexibility of the strength of the muscles.
After finishing the physical examinations, some tests and investigations might be needed to confirm the diagnosis, such as:
- Spinal X-ray. It is very important to look for spinal fractures, tumors, disk problems, or bone spurs.
- Magnetic resonance imaging or CT scans to see detailed views of the bones and soft tissues of the back. MRI can show disk herniation, pressure on nerves, or any arthritic condition that may be pressuring the nerves. MRIs are required usually to confirm the diagnosis of sciatica.
- Electromyography or nerve conduction studies examine how well the nerve can conduct electrical impulses and the response of the muscles.
- Myelogram to determine if a disk herniation is causing the problem.
After confirmation of the diagnosis, what’s next?
How is sciatica treated?
The ultimate goal of sciatica treatment is to decrease the pain and increase mobility. With some simple self-care measurements, sciatica pain can go away after a while. However, the best way to alleviate sciatica pain is to do sciatica exercises
Here are some of the best exercises to alleviate sciatica pain:
- Reclining pigeon pose. It is a common yoga pose that opens the hips. There are multiple versions of this type of pose, the first is a starting pose called reclining pigeon pose. If you are just starting your treatment. You should try this pose.
- Sitting pigeon pose. In this pose, the patient sits on the floor with their legs stretched out in front of them. Then, they should bend their right leg to put the right ankle on the top of the left knee. The patient leans forward to reach the right side with their upper body and hold it for 15 to 30 seconds. Then the patients should repeat the same steps on the other side.
- Knee to the opposite shoulder. It is a simple stretch that relieves sciatica pain by loosening the gluteal and piriformis muscles, which are sometimes inflamed and press against the sciatica nerve. In this stretch, the patients lie on their back with their legs extended and feet flexed upward. Then the patients should bend their right legs and clasp their right hands around their knees.
- Sitting spinal stretch. Sometimes sciatica pain develops when the spinal vertebrae compress on the nerves. This stretch creates a space in the spine so it relieves pressure on the sciatic nerve. In this stretch, the patients sit on the ground with their legs extended and their feet flexed upward. Then they should bend the right knee and put the foot flat on the floor on the outside of the opposite knee. Then patients should place their left elbows on the outside of the right knee to help the body to turn towards the right gently and hold for 30 seconds and repeat three times.
- Standing hamstring stretch. It helps relieve the pain and tightness in the hamstring caused by sciatica.
- Forward pigeon pose.
All these stretches can help sciatica patients to improve the quality of their day-to-day life. They only need to get the help of a professional to improve the quality of their daily activities and alleviate their pain.