Acute Back Pain Scenario

As you gain further information, you collect the following observations: 88 HR, 20 RR, 125/86 BP, 98% SpO2, 36.7 temperature, 6.2 BM, and GCS 15. Which observation listed here will score on your NEWS table?

You find all observations are normal and the NEWS score is 0. The pain seems to originate from the top of the left buttock, left of the lower spine, and travels down the left leg. It feels fine at rest, but once moving, the pain becomes aggravated. Certain positions also increase the pain, including sitting down. Lying down seems to relieve it. The pain feels nerve-related, with occasional burning sensations. It only travels down the left leg. Given there is no history of any recent trauma, surgery, or any events which may have caused damage to the patient, what is the more likely diagnosis?

You think the patient may be experiencing sciatica pain. What questions may be specific to forming a management plan for sciatica?

The pain has been getting worse as they have been working in the garden over the weekend. They can weight bear and can struggle to the toilet but following movement they have to rest to calm it down. They report a tingling or pins-and-needles feeling down the affected leg when the pain gets worse. Is this sign a red flag for cauda equina?

What red flags of cauda equina should you explore to rule this pathology out when assessing your patient?

What other serious conditions may you want to explore when assessing suspected sciatica patients?

There are no fever symptoms, no weight loss or history of cancer, and no trauma or other reason to suspect fractures due to the gradual onset of symptoms. You think this is sciatica. What initial route would you think is more appropriate to manage this patient?

You call the GP as the patient could do with further pain relief to manage at home. What pain relief is recommended by NICE guidelines for acute sciatica pain? 

The GP is happy with your referral and will contact the patient directly later to organise a prescription. What other self-management advice can you give that should help recovery and symptom management?

Which condition can present very similarly to sciatica?

What best describes piriformis syndrome?

Piriformis syndrome causes nerve compression further down the buttock, whereas sciatica is caused by nerve compression at the spine.

Where does the sciatic nerve originate from in the spine?

Sciatica is most commonly caused by:

If diagnosed with a herniated lumbar disc, surgery is the only option for recovery; consequently, most people suffering with acute sciatica require surgical intervention.