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QI have a shooting pain down my leg that is worse on some days, and I think I have sciatica. When should I see a doctor and how is sciatica treated?

APain shooting down your leg is a telltale sign you have sciatica as opposed to another type of back pain, such as discomfort caused by muscle strain. Sciatica is nerve pain that starts in the lower back and/or buttock and radiates down one leg.

The most common cause is a bulging disc in the spine that is pressing on the sciatic nerve. Also called a herniated or slipped disc, it can occur from wear-and-tear over time or from an injury. The gel-like interior of the disc protrudes through a tear in its outer ring and pinches a nerve.

Sciatica is commonly described by patients as pain with an “electrical” or “burning” character. Others describe feeling “ice water running under my skin” or “ants crawling over” a particular affected area. Symptoms may worsen when you bend over, lift something, twist, sit down, or even cough or sneeze.

The encouraging news is that sciatica usually goes away on its own. About 75 percent of patients get better within a few weeks to a few months as the bulging disc shrinks and stops irritating the nerve. Most people do not need surgery.

As for when to see a doctor, patients with mild and welltolerated symptoms may be able to wait it out and see if the pain resolves on its own. They can try resting a bit and avoiding activities that make the pain worse. An over-the-counter antiin ammatory such as ibuprofen or naproxen can help, unless a patient is unable to take this medication. If pain does not improve within a week or two, there is no downside to seeing a doctor. One’s primary care physician is a good place to start.

Less frequent causes of sciatica include a bony growth on the spine that is pressing on a nerve, a fracture or an infection. If the pain is very bad or an individual experiences signi cant weakness or numbness, it’s a good idea to see a doctor sooner rather than later.

Anyone who experiences changes in bladder or bowel control should see a physician immediately. Pain accompanied by fever could be a sign of infection − another reason to seek medical care without delay.

Answer from Matthew Cunningham, MD, PhD, a spine surgeon at Hospital for Special Surgery (HSS) in New York City and at HSS Long Island.

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