Sciatica: Detection and Confirmation by New Method

Abstract

We need to overcome limitations of present assessment and also integrate newer research in our work about sciatica. Inflammation induces changes in the DRG and nerve root. It sensitizes the axons. Nociceptor is a unique axon. It is pseudo unipolar: both its ends, central and peripheral, behave in similar fashion. The nerve in periphery which carries these axons may selectively become sensitive to mechanical pressure--“mechanosensitized,” as we coin the phrase. Many pain questionnaires are used and are effective in identifying neuropathic pain solely on basis of descriptors but they do not directly physically correlate nerve root and pain. A thorough neurological evaluation is always needed. Physical examination is not direct pain assessment but testing mobility of nerve root and its effect on pain generation. There is a dogmatic dominance of dermatomes in assessment of leg pain. They are unreliable. Images may not correlate with symptoms and pathology in about 28% of cases. Electrophysiology may be normal in purely inflamed nerve root. Palpation may help in such inflammatory setting to refine our assessment further.Confirmation of sciatica is done by selective nerve root block (SNRB) today but it is fraught with several complications and needs elaborate inpatient and operating room set up. We have used the unique property of the pseudo unipolar axon that both its ends have similar functional properties and so inject along its peripheral end sodium channel blockers to block the basic cause of the mechanosensitization namely upregulated sodium channels in the root or DRG.Thus using palpation we may be able to detect symptomatic nerve in stage of inflammation and with distal end injection, along same inflamed nerve we may be able to abolish and so confirm sciatica. Discussions of sciatica pain diagnosis tend to immediately shift and centre on the affected disc rather than the nerve. Theoretically it may be possible to detect the affected nerve by palpating the nerve and relieve pain moment we desensitize the nerve.

<p>Therapeutic Efficacy and the Impact of the “Dose” Effect of Acupuncture to Treat Sciatica: A Randomized Controlled Pilot Study</p>

“…Sciatica primarily involves the L4 and L5 to S1 dermatomes. 2,32 The BL and GB meridians are mostly distributed in the L4, L5, and S1 dermatomes, and the KI, stomach (ST) and spleen (SP) meridians are generally distributed in the L4 and S1 dermatomes. Recent research reveals that acupuncture stimulation in the sciatic nerve trunk is more effective in relieving pain compared with simple routine acupuncture.…”

Novel technique of diagnosing and reducing pain in cervical radiculopathy

“…So we are left with various authors describing the particular tests differently. Gore and Nadkarni, had described a technique to diagnose sciatica by palpating the sensory afferent of the affected nerve distally in ankle [7] . We have designed a similar study wherein we palpated the sensory afferent nerves of the affected upper limb.…”

“…Peripheral pain input is documented as necessary for persistence of pain states which leads to unresolved nociceptor sensitization [26] . This sensitization is detected by palpating the nerve also called as mechanosensitisation [7] . The ongoing nociceptive afferent input from a peripheral focus causes allodynia.…”

“…The radicular pain is mostly due to radiculitis, an inflammatory pain sensation [6] . This pain can be elicited by palpating the nerve distally [7] . In cervical radiculopathy the pain distribution pattern is nondermatomal, with the exception of C4 dermatome.…”

Response to: “Some patients with chronic pain need low-dose opioid therapy for survival and quality of life”

“…Neuropathic pain can also be diagnosed through palpation along the course of the affected nerves, because these nerves are larger than normal and more sensitive to pressure. 3,4 Ultrasonography can also be used to make this diagnosis. 5,6 For patients with neuropathic pain, there are nonnarcotic options for treating their pain.…”