My wife and several of her family members suffer from an extremly painful nerve in the buttocks that affect their comfort day and night. They all say the same thing, that it starts in the butt, and goes down to the knee,and also up into the lower back. My wife has been told it is the sciatic nerve, but any treatments have been seemingly temporary. This is slightly less painful when they move around, but cannot get comfort when sitting or sleeping, can actually be more intense, which affects quality and quantity of rest. Sleep may not be obtained without pills at times, and I am hoping you can suggest a treatment or specialist that deals with this particular disorder. Thank you .

I guess sciatica (pain from irritation of the sciatic nerve as it leaves the spinal column) is common enough that several people in a family could have it at the same time. Just remember that it's not contagious!

Seriously, sciatica is very common and is usually the result of back strain. It is more common in people who are a little bit out of shape physically, for example overweight, with tight hamstrings, and/or weak abdominal muscles -- but anyone can get it if they have a bad fall, lift something too heavy, or have some other accident that can twist the back. Often it is caused by a bulging disc in the back, which can press on the nerve and cause the pain. Usually, with a combination of modified activity, back exercises that can be prescribed by a doctor or physical therapist, and some anti-inflammatory medication, the pain will resolve completely within a couple of months. People with sciatica are at risk for getting it again if they don't change their habits. In some cases where the pain becomes chronic, an MRI scan is needed to determine if there is anything that needs more invasive procedures, such as an ingjection into the spine to relieve the pain. And, in some severe cases, if the symptoms are accompanied by severe and unremitting pain or by weakness in the leg, surgery may even be needed. There is now a wide range of surgeries that are available, so it's wise to ask about the full range of options available before proceding.

If you have family members who have pain that's not getting better, I suggest they see their doctor. If their doctor has run out of ideas, then they should be referred to a pain specialist or to a back surgeon (for example, an orthopedist or neurosurgeion, depending on which type of specialist is most available and experienced in your area). In addition, many communities have multidisciplinary pain clinics that can assist with pain management in cases where the pain is chronic but surgery is unlikely to help. Usually these clinics are staffed by anesthesiologists, neurologists, and mental health practitioners who are specially trained in pain medicine.

Dr. Mike Potter

-- Michael Potter, MD, is an associate professor at the University of California at San Francisco Medical Center.

First published March 29, 2005
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