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Brief Summary
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Sciatica is a symptom
rather than a specific diagnosis. Available evidence from basic science and
clinical research indicates that both inflammation and compression are
important in order for the nerve root to be symptomatic.1
Affected patients experience pain and paresthesias in the sciatic nerve
distribution or an associated lumbo-sacral nerve root. Sciatica pain often is
worsened with twisting, bending, or coughing. This is often a chronic condition
that is managed through the use of analgesics to control the pain and NSAIDs to
decrease inflammation. This activity illustrates the evaluation and management
of sciatica and reviews the role of the inter-professional team in improving
care for patients with this condition.2
The lifetime incidence of this condition is estimated to
be between 13% and 40%. Fortunately, the majority of cases resolve spontaneously
with simple analgesia and physiotherapy. However, the condition has the
potential to become chronic and intractable, with major socio-economic
implications. In about 90% of cases sciatica is caused by a herniated disc with
nerve root compression, but lumbar stenoses and (less often) tumours are
possible causes. Epidemiological factors found to influence incidence of
sciatica included increasing height, age, genetic predisposition, walking,
jogging (if a previous history of sciatica), and particular physical
occupations, including driving.
The influence of herniated nucleus pulposus and the
probable cytokine-mediated inflammatory response in lumbar and sacral nerve
roots is discussed. An abnormal immune response and possible mechanical factors
are also proposed as factors that may mediate pain. The diagnosis of
sciatica and its management varies considerably within and between countries;
for example, the surgery rates for lumbar discectomy vary widely between
countries. The ongoing issue of
the role of epidural steroid injection in the
treatment of this condition is also discussed, as well as potential hazards of
this procedure and the direction that future research should take.3,4
Gnaphalium – General Literature Review:
The genus Gnaphalium, a herb distributed worldwide, comprises
approximately 200 species of the Compositae (Asteraceae) family that belongs to
the tribe Gnaphalieae. Some species are traditionally used as wild vegetables
and in folk medicine. More than 125 chemical constituents have been
isolated from the genus Gnaphalium, including flavonoids, sesquiterpenes,
diterpenes, triterpenes, phytosterols, anthraquinones, caffeoylquinic acid
derivatives, and other compounds. The extracts of this genus, as well as
compounds isolated from it, have been demonstrated to possess multiple
pharmacological activities such as antioxidant, antibacterial and antifungal,
anti-complement, antitussive and expectorant, insect antifeedant, cytotoxic,
anti-inflammatory, antidiabetic and antihypouricemic properties.6
Gnaphalium – Homoeopathic Literature
Review:
A remedy of unquestioned benefit in sciatica, when pain
is associated with numbness of the part affected. Cramps in
calves of legs and feet when in bed. Rheumatic pain in ankle joints and legs. Intense
pain along the sciatic nerve; numbness alternates with pain. Frequent pains in
calves and feet. Anterior crural neuralgia.7 Pains dull or
darting or cutting from Right hip-joint posteriorly downward to foot; <
lying down, from motion, by stepping, > sitting in a chair.-Intense pain
along sciatic nerve.-Numbness occasionally taking the place of sciatic pains,
making exercise very fatiguing.-Cramps in calves; in feet, at night in bed.8
Bibliography:
1. Valat JP, Genevay S, Marty M, Rozenberg S, Koes
B. Sciatica. Best Pract Res Clin Rheumatol. 2010 Apr;24(2):241-52. doi:
10.1016/j.berh.2009.11.005. PMID: 20227645.
2. Davis D, Maini K, Vasudevan A. Sciatica.
3. https://www.ncbi.nlm.nih.gov/books/NBK507908/
4. Koes BW, van Tulder MW, Peul WC. Diagnosis and
treatment of sciatica. BMJ. 2007 Jun 23;334(7607):1313-7. doi:
10.1136/bmj.39223.428495.BE. PMID: 17585160; PMCID: PMC1895638.
5. Stafford MA, Peng P, Hill DA. Sciatica: a
review of history, epidemiology, pathogenesis, and the role of epidural steroid
injection in management. Br J Anaesth. 2007 Oct;99(4):461-73. doi:
10.1093/bja/aem238. Epub 2007 Aug 17. PMID: 17704089.
6. Zheng X, Wang W, Piao H, Xu W, Shi H, Zhao C.
The genus Gnaphalium L. (Compositae): phytochemical and pharmacological
characteristics. Molecules. 2013 Jul 15;18(7):8298-318. doi:
10.3390/molecules18078298.
7. Boericke W. Materia medica with repertory.
InMateria medica with repertory 1927 (pp. 1049-1049).
8. Clarke JH. A dictionary of pratical materia
medica. homoeopathic publishing Company; 1902. |