Sciatica management in ER

The other day In ER, I met a 51 year old overweight transport driver presenting with severe sciatica.  His last episode was several years ago; they seem to come on without apparent injuries. This one seems much worse.

He had no “red flags” for more sinister etiologies; so I explained to him that pain is like the warning lights on the dash of a vehicle.  A mechanic can either cover up the warning light with something like duct tape or get curious about what has caused the warning light and make necessary corrections.  In the case of sciatica, the pain is due to compression of the lumbar nerves by the gradual loss in integrity of adjacent structures. While, these structure may deteriorate irreversibly from injuries and advancing age; they can also reversibly decompensate from poor nutrition, poor posture and lack of exercise.  I suggested he increase his non-starchy vegetable intake to 400 grams daily; begin the ongoing practice of the lumbar decompression / core strengthening exercise we discussed. I also share with him my personal experiences with chronic sciatica. By being curious rather than fearful of the pain, I am able to respond appropriately rather than reacting inappropriately.  By being grateful rather than resentful of the pain, I am able to experience life fully.

He and his wife were grateful that he did not receive the “duct tape” solution; that the sciatica has served as a “warning light” to prevent many other worse possibilities;  that by eating each meal and living each moment mindfully, they can expect wonderful possibilities.

They smiled and thanked me as they walked out slowly.