what kind of doctor would one see for sciatica?

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Su4n2

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ok, i have had this horrible pain for 10 days, everyone tells me the symptoms sound just like sciatica. i thought it would go away, but it hasn't and i have some kind of flare up once a day. since i start med school in 2 weeks, i am a little worried as i have a hour commute each way. everyone says there is nothing to do, but ithink i should get checked out. so, neuro, PM&R, ortho, whom do i see? or any anecdotal hints from people who have had it. thanx.
- in pain susan

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Go see a primary care physician -- they see patients with back pain every day. If nothing else, they may refer you to physical therapy, but you can at least start there.
 
thanx, i thought about that, but i don't have a lot of time. and i know he will end up referring me anyway, honestly i have never gone for anything that he can do. also, it's not back pain, so maybe it's not sciatica. it's excruciating upper thigh/butt pain that shoots down my leg. i will prob end up calling and asking my PCP where to go.
 
p.s i don't think i will have time fot PT- starting MS1 in 2 weeks. oy!
 
Anti-inflammatories (esp. Celebrex, etc.) if it is sciatica. If you're overweight, try to lose some and avoid activities that aggravate it.
 
thanx. i am not overweight and not sure what brought this on. i was swimming one day and there it was. now every time i work out, go up stairs, lift, etc it comes back. i was hoping it would go away, that's why i haven't gone to the doctor yet.
 
Try seeing a physiatrist or neurologist, especially ones trained in Pain Management. Both doctors are very good at treating sciatica or other nerve problems that you may be having.
 
From personal experience, I'd recommend a PM&R doc. There is a good chance, though, it could go away on it's own or with some PT. Therefore you should not go to a surgeon until all other routes have been tried and failed (very unlikely).
 
Psych or neurologist?
Interesting approach
The differential is diverse but certainly you don?t start visiting every specialist potentially involved
Start with a primary care physician (yes probably he will refer you but he will try to find out who to refer you to!)
If you need anti-inflammatory drugs it would be better if someone prescribed them for you
(people,The psychological factor is good to remember but is always a diagnosis of exclusion)
 
i am only a medical student ,
There are plenty of more qualified people on this forum to answer your question but I felt like posting because after the first answer I believe you got some confusing ones
 
PTCA

I believe you read the above post incorrectly. The poster said "Try seeing a physiatrist" NOT a psychiatrist.

A physiatrist is a physician who specializes in Physical Medicine and Rehabilitation (PM&R)

Neurologist also work with sciatica. To the OP, I would add an anesthesiologist with pain management fellowship training to the list. They could be very helpful.
 
hey, guys- just an update. i haven't had many major flare ups in 2 days, so i am going to wait and see. primary reason that i haven't gone to pain management is that i am reluctant to be on pain meds. i am not sure why, but i would like to solve this w/working out, etc. in addition, since i will be starting an osteopathic school in 2 weeks, i would like to see if there's a different approach other than pain meds and anti-inflammatory. thanks to all who have contributed.
 
90% of lower back pain improves without doing anything. If you see a doctor now, all he'll probably do is prescribe some NSAIDs or something and tell you to return in 6 weeks.

Beware, I know some family med docs who prescribe CORTICOSTEROIDS as first line therapy. Unreal.
 
Dude, you should still go see your doctor. Sure, you may be feeling somewhat better now, but that doesn't mean that your pain won't come back. I know everyone's recommending subspecialists, but really any competent primary care doctor should be able to handle run-of-the-mill back pain/sciatica without having to give out any referrals. I personally manage the back pain of my primary care continuity clinic patients, and I very rarely have to send them to a physiatrist or other subspecialist (I only refer the ones with concerning exams/symptoms or those who are not getting better with the 1st line interventions). If you don't like the advice your PCP gives you, then go to a different one. The nice thing about primary care docs is that you don't have to wait for weeks to months to see them -- you can go to an urgent care clinic.

Pain specialists are nice, but they usually deal with difficult-to-treat pain, and focus in narcotics, nerve blocks, etc. Neurologists also tend not to deal with run-of-the-mill back pain. If you go to your PCP, they can at least examine you, make sure you don't have any concerning "red flags" on exam or history, then give you ibuprofen and show you excercises you can do at home to work on back strengthening and pain control. If you do have concerning signs, they can at least decide on the initial studies to do, and who the most appropriate referral will be. I understand you don't have time for physical therapy, but all you really need is one visit to your PCP or physical therapist so that they can teach you exercises -- there's no need for you to go in 3x/week.

PS -- I would certainly not recommend waiting until you start med school to figure out how to approach your sciatica. There is a problem among preclinical med students of self-diagnosis and self-treatment, which can sometimes cause more problems than it can help, and often all these things need in order to get solved is a single trip to a physician.

Okay, I'll get off my soapbox now... :)
 
AJM,

i will be going to the doctor this week to fill out my health forms. i will certainly inquire. i am willing to bet he will just say, i think i should refer u to a specialist. don't get me wrong- he is a good doctor, i just think that for a 24 year old, there's not much he could other than 1. rule out/confirm som horrible 2. give antibiotics 3. tell me not to sweat it cause it's viral. here's a breakdown in the last year of me going to him
1. i thought i had a sty- he wasn't sure, thought i had some weird thing where my glands produced some kind of oil, yadda, yadda- referred me to optho. turned out it went away on its own

2. had a GYN issue- referred to GYN
3. needed my TSH checked cause thought i have a cyst, he checked turned out normal. above GYN says i have goiter, sends me to endocrinologist who confirms.
4. i think i have strep- go in and get culture

i just feel that for a young person who doesn't need to have different diseases/systems managed by one person , it has been a total waste to go to him. i wish i would have gone straight to optho for that sty, or the endo for TSH, this would all save me time and copay money.

anyway, now that u know my entire medical history and prob think i am a osycho, i will report back and tell u what he says.


p.s this is not to say that i don't respect PCP's- i have seen then in action with patients with complicated histories, various diseases and meds, and i am amazed that they can put it all together.
 
PTCA
I believe you read the above post incorrectly. The poster said "Try seeing a physiatrist" NOT a psychiatrist.

A physiatrist is a physician who specializes in Physical Medicine and Rehabilitation (PM&R)

Neurologist also work with sciatica. To the OP, I would add an anesthesiologist with pain management fellowship training to the list. They could be very helpful.

you are right
Sorry bout that
i guess i was kind of sleepy.
PM&R could be ok (given patients age and history)
I think it is anaesthesiologists primarily dealing with pain management myself,but I don?t think that is the sort of help one needs at this point.
 
Depends on where you practice. Where I went to school, PMR did epidural steroids and all sorts of other things that you'd expect Gas to do.
 
Su4n2,
I think you'll be pleasantly suprised with an OMM specialist. You might need an X-ray or MRI to confirm that there are no slipped disks or a narrowing of the vertebral foramen but if your workouts are not "killing" you I don't see what the contraindications to some muscle energy or HVLA might be. Maybe someone else can add something here since I'm only a second year. One of the docs at the school your going to will definitely be able to answer your questions. :)
 
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