Treatment Options Compounding Pharmacists Can Offer to Patients with Chronic Sciatic Nerve Pain
Out of the blue, an intolerable pain shot from Ben’s lower back down the length of his leg. After that, every step was agony, as if needles were being stuck in his foot. His doctor diagnosed sciatica, which turned out to be the beginning of a long struggle. More than half of all patients with sciatica have persistent symptoms after four years. During that time, about 20 percent of them won’t be able to work. When it comes to stopping sciatic nerve pain, compounding pharmacists have an important role to fill by formulating topical treatments that relieve pain.
Essential Facts about Sciatica
Sciatica refers to a set of symptoms associated with the sciatic nerve. Since that’s generic—and true sciatica involves compression of the nerve plus radiating pain—physicians often prefer to use the diagnostic term of radiculopathy with lumbar disc herniation. However, ICD-10 has billable codes for sciatica and radiculopathy. While sciatica is commonly caused by a herniated disk, it can also result from any condition that places pressure on the nerve. Different methods of assessing symptoms have created prevalence estimates ranging from 1.2 percent to 43 percent.1
Symptoms from sciatica tend to occur rapidly. For many patients, the pain resolves with conservative treatment, but healing can take months and after a period of remission, symptoms often recur in persistent cycles.2 The key qualities that set sciatica apart from other lower back problems include:
- Characteristic sciatic nerve pain that begins at the nerve root in the lumbar spine, radiates from the lower back, down the buttocks and leg, and sometimes to the foot and toes
- Symptoms usually occur in one leg.
- Can include tingling, numbness or weakness of the leg.
- Pain is often worse with movement and relieved by rest.
Conservative Treatment Protocols
Conservative treatment is followed for the first six to eight weeks, with patients using over-the-counter pain relief and alternating hot and cold packs. For years, bed rest was recommended, then doctors began to advise activity to avoid muscle atrophy. However, studies so far haven’t proven one method to be more effective than the other. When experts reviewed the research published as of June 2010, they found moderate quality evidence that patients with lower back pain may get a little more pain relief from activity than bed rest, but there was no therapeutic difference between bed rest and activity in patients with sciatica.3
Meanwhile, various articles appeared referring to the 2010 review as proof that there’s no excuse for bedrest. A physician was quoted as saying, “The fact that no new study has been published in nearly 10 years shows that research done in the past proved the point.”4 By comparison, authors of the 2010 report concluded that future research would have an important impact on treatment decisions.
All of this background information is important for compounding physicians to keep in mind as they encounter patients dealing with sciatica. Some patients may be confused after browsing the Internet for answers while others are torn between pain-relieving rest versus instructions to stay active to facilitate healing. Treatment must be based on each patient’s tolerance of pain and level of mobility. Physical therapy is a good middle ground that encourages structured activity with professional supervision to prevent further injury.
Medication Efficacy and the Role of Compounding Pharmacists
Oral steroids are often prescribed when conservative measures don’t help, but a report issued in 2015 noted that steroids may not be effective for sciatic nerve pain. When existing studies were reviewed, the experts were surprised to learn that patients taking steroids had modest improvement in functioning but they didn’t get any significant pain relief.5 In light of this review—and considering the potential for adverse reactions from oral steroids—topical treatments are ideal options for targeting trigger points and relieving pain so that patients can stay active.
Compounding pharmacists have an edge for treating sciatica because each patient finds optimal pain relief from different combinations of pharmaceuticals.
- Medications to consider include ketamine, gabapentin, and baclofen mixed in a penetrating base. Treatment consisting of ketoprofen 5% and gabapentin 5% has been successful for treating neuropathy.
- Patients may also find pain relief from topical menthol, capsaicin, and lidocaine. Prepared patches combining lidocaine and menthol are convenient for pharmacists and easier for patients to use than creams or gels.
Outreach Tips: The type of chronic pain caused by sciatica, and the resulting challenge to normal daily activity, often affects mood and causes a feeling of defeat. When you reach out to patients and recommend compounded options, you also offer hope and encouragement. Pharmacists can also help by having handouts available with information about local physical therapists and adjunctive therapies such as massage, yoga, and chiropractic.
Some patients seeking advice for low-back or leg pain may not have sciatica. Cramped and knotted muscles from over-activity can put pressure on nerves and cause symptoms similar to sciatica. These patients will benefit from the same topical treatments, but first do a quick assessment to determine whether they should consult their physician.
Patients should see their physician if6:
- Back pain follows trauma
- Pain lasts more than four to six weeks or gets worse
- Pain is worse when lying down
- Patient has numbness, tingling, or altered sensation
- Have fever, swelling, redness, or changes in body functions
Compounding Pharmacists May Help Prevent Recurrence
Activity improves recuperation in many types of musculoskeletal and nerve conditions. Even though strong scientific evidence is lacking for sciatica treatment, most health care professionals believe that activity is the key factor for healing. Compounding pharmacists can offer hope that topical treatments may prevent sciatica recurrence by enabling activity, but this is a treatment option many patients won’t know about unless compounding pharmacists reach out and offer to help.
Pharmaceutica North America provides the bulk APIs, pre-mixed products, and quality delivery bases you need to formulate topical treatments for patients with sciatica. Please contact us to learn about how our pure, high-quality compounding materials can support your business.
- “Sciatica: Review of Epidemiological Studies and Prevalence Estimates,” October 2008, http://www.ncbi.nlm.nih.gov/pubmed/18923325 ↩
- “The Clinical Effectiveness and Cost-Effectiveness of Management Strategies for Sciatica: Systematic Review and Economic Model,” November 2011, http://www.ncbi.nlm.nih.gov/books/NBK99305/ ↩
- “Advice to Rest in Bed Versus Advice to Stay Active for Acute Low-Back Pain and Sciatica,” June 2010, http://www.ncbi.nlm.nih.gov/pubmed/20556780 ↩
- “Low Back Pain is No Reason to Stay in Bed,” June 2010, http://www.cfah.org/hbns/2010/low-back-pain-is-no-reason-to-stay-in-bed ↩
- “Oral Steroids for Acute Radiculopathy Due to a Herniated Lumbar Disk,” May 2015, http://jama.jamanetwork.com/article.aspx?articleid=2293294 ↩
- “Should I See a Doctor for Back Pain?” August 2007, http://www.spine-health.com/conditions/lower-back-pain/should-i-see-a-doctor-back-pain ↩