Overview of Multiple Sclerosis and Sciatica
Sciatica is a condition that causes radiating pain along the sciatic nerve, which runs down the legs from the lower back.(1,2,3) Sciatica pain is caused by a bone spur or herniated disc in the spine, which presses down on the nerve.(4) Sciatica pain originates in the spine and travels down the back of the leg. This type of pain usually only affects one side of the body.(5) The common treatment for sciatica pain is medication and physiotherapy.(6)
On the other hand, multiple sclerosis is an autoimmune disease that causes the immune system to attack the protective covering of the nerves, known as the myelin sheath. The resulting nerve damage causes disruption in the communication between the brain and body and can also cause neuropathic pain. Neuropathic pain is a common symptom in people with multiple sclerosis. This type of neuropathic pain results from the damage caused to the nerves of the central nervous system, leading to a sharp, stabbing, or burning sensation.(7,8)
People with multiple sclerosis who also experience sciatica pain usually just assume that the pain is because of their multiple sclerosis. However, the neuropathic pain of multiple sclerosis is restricted to the central nervous system and does not involve the sciatic nerve. The pain of multiple sclerosis, though, also has several different causes and mechanisms than the pain of sciatica.(9,10)
However, a person can have sciatica and multiple sclerosis together. There are many different types of challenges associated with living with sciatica and multiple sclerosis. Nevertheless, the consensus amongst experts is that the two conditions are unrelated. Let’s take a closer look.
What Is The Difference Between Sciatica and Multiple Sclerosis Pain?
Multiple sclerosis is an autoimmune disorder. In this condition, the immune system itself attacks the myelin sheath, which is the protective layer that surrounds the nerve fibers. This impacts the pathways of the central nervous system that is responsible for regulating the sensations and feelings in the body. Due to this, multiple sclerosis can cause various types of painful sensations in the body, including:(11,12)
- Muscle spasms
- Shock-like sensations that travel down from the back to the lower limbs
- Feelings of tingling, burning, and pain in the lower legs.
The major reason behind this pain of multiple sclerosis happens due to the damage caused to the brain’s neural pathways.
However, there is a difference between the pain caused by multiple sclerosis and the pain caused by sciatica. The major difference between sciatic pain and multiple sclerosis pain is that the pain pathway of sciatica is not an autoimmune response. Instead, it happens because of the bodily stressors placed on the sciatic nerve. Sciatica pain is typically caused by habits or changes in the lower body that twist or pinch the sciatic nerve.
Some of the common causes that put pressure on the sciatic nerve are bone spurs, herniated disks, and even obesity. (13) People who live a sedentary lifestyle and are prone to sitting for long periods of time are also likely to experience symptoms of sciatica.
The biggest difference between the pain caused by these two conditions is that multiple sclerosis causes dysfunction of the signaling and pathways of the central nervous system. On the other hand, in sciatica, the most common cause of the pain is the pinching or straining of the sciatic nerve.
Association Between Sciatica and Multiple Sclerosis
Nearly 40 percent of Americans report experiencing sciatic pain at some point or the other during their lives.(14) This is why it is not unusual that people with multiple sclerosis also experience sciatica without realizing it.
Multiple sclerosis can cause changes to the body as well as your activity level. Reduced mobility may also cause longer periods of sitting, which is again a risk factor for sciatica.(15,16)
There is some evidence to show that the lesions caused by multiple sclerosis can also affect the sciatic nerve. In fact, a study carried out in 2017 compared 36 people with multiple sclerosis to 35 people who did not have multiple sclerosis.(17) All the participants of the study underwent magnetic resonance neurography, which is an advanced technology for getting high-resolution images of the nerves. The research team discovered that people with multiple sclerosis had more lesions on their sciatic nerve as compared to those who did not have multiple sclerosis.(18)
However, this is the only study that has demonstrated how the peripheral nervous system is also involved in people with multiple sclerosis. While some experts believe that this research is sufficient to change the manner in which multiple sclerosis is diagnosed and treated, others believe that more research is still needed to actually understand the exact involvement of the peripheral nervous system, including the sciatic nerve, in people with multiple sclerosis.
What To Do For Sciatica Pain?
It is difficult to distinguish between pain caused by sciatica and multiple sclerosis. Sciatica pain is present in a unique manner in that you will feel like the pain is moving from the lower spine to your buttocks and then further down to the back of your leg. It presents as if it is traveling down the length of that one nerve. Also, sciatica pain usually presents in one leg only. This is because the pinching of the nerve that causes the pain is generally limited to only one side of the body.(19)
There are several treatments for sciatica pain that vary depending on the severity of the pain. These include:
- Physiotherapy for correcting your posture if that is straining the nerve. Physical therapy is also needed to strengthen the support muscles around the affected nerve.
- Medications such as muscle relaxants, anti-inflammatories, narcotics, anti-seizure medications, and tricyclic antidepressants in severe cases.
- Over-the-counter pain relievers
- Steroid injections like corticosteroids
- Lifestyle changes like regular exercise, better posture for sitting and walking, or weight loss
- Chiropractic adjustment
Surgery is usually the last option for treating sciatica pain. It is typically only used in cases where there is a loss of bladder or bowel control or where none of the other treatments have found success. In conditions where a herniated disk or a bone spur is causing the pain by pinching the sciatic nerve, surgery is usually the only option for correcting the condition.
It is essential that you understand that certain medications may cause an adverse interaction with your multiple sclerosis medications and treatment. Your doctor will help you know which is the right treatment for you for both the conditions. They will also help you formulate an exercise routine to work around your condition and pain.
It is very easy to mistake sciatica pain as being a symptom of multiple sclerosis, which is known to cause neuropathic pain. However, even though the two conditions can exist together, sciatica is not caused by multiple sclerosis. It is a different condition that is caused by pressure or pinching of the sciatic nerve. There are many treatments for sciatica, and it can be correct. Your doctor will help you find out the best remedy for sciatica pain while also keeping in mind that you have multiple sclerosis.
- Valat, J.P., Genevay, S., Marty, M., Rozenberg, S. and Koes, B., 2010. Sciatica. Best Practice & Research Clinical Rheumatology, 24(2), pp.241-252.
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- Frymoyer, J.W., 1988. Back pain and sciatica. New England Journal of Medicine, 318(5), pp.291-300.
- Heliövaara, M.A.R.K.K.U., Mäkelä, M.A.T.T.I., Knekt, P.A.U.L., Impivaara, O.L.L.I. and Aromaa, A.P.R.O., 1991. Determinants of sciatica and low-back pain. Spine, 16(6), pp.608-614.
- Koes, B.W., Van Tulder, M.W. and Peul, W.C., 2007. Diagnosis and treatment of sciatica. Bmj, 334(7607), pp.1313-1317.
- Sospedra, M. and Martin, R., 2005. Immunology of multiple sclerosis. Annu. Rev. Immunol., 23, pp.683-747.
- Ferguson, B., Matyszak, M.K., Esiri, M.M. and Perry, V.H., 1997. Axonal damage in acute multiple sclerosis lesions. Brain: a journal of neurology, 120(3), pp.393-399.
- Clifford, D.B. and Trotter, J.L., 1984. Pain in multiple sclerosis. Archives of Neurology, 41(12), pp.1270-1272.
- Österberg, A., Boivie, J. and Thuomas, K.Å., 2005. Central pain in multiple sclerosis–prevalence and clinical characteristics. European Journal of Pain, 9(5), pp.531-542.
- Solaro, C., Brichetto, G., Amato, M., Cocco, E., Colombo, B., D’aleo, G., Gasperini, C., Ghezzi, A., Martinelli, V., Milanese, C. and Patti, F., 2004. The prevalence of pain in multiple sclerosis: a multicenter cross-sectional study. Neurology, 63(5), pp.919-921.
- Archibald, C.J., McGrath, P.J., Ritvo, P.G., Fisk, J.D., Bhan, V., Maxner, C.E. and Murray, T.J., 1994. Pain prevalence, severity and impact in a clinic sample of multiple sclerosis patients. Pain, 58(1), pp.89-93.
- Mulleman, D., Mammou, S., Griffoul, I., Watier, H. and Goupille, P., 2006. Pathophysiology of disk-related sciatica. I.—Evidence supporting a chemical component. Joint Bone Spine, 73(2), pp.151-158.
- Publishing, H., 2020. Sciatica: Of All The Nerve – Harvard Health. [online] Harvard Health. Available at: <https://www.health.harvard.edu/pain/sciatica-of-all-the-nerve> [Accessed 31 October 2020].
- Chen, S.M., Liu, M.F., Cook, J., Bass, S. and Lo, S.K., 2009. Sedentary lifestyle as a risk factor for low back pain: a systematic review. International archives of occupational and environmental health, 82(7), pp.797-806.
- Jain, N., 2013. Slip disc with sciatica-Newer non-surgical treatment. Journal of International Medical Sciences Academy, 26(4), pp.249-51.
- Jende, J.M., Hauck, G.H., Diem, R., Weiler, M., Heiland, S., Wildemann, B., Korporal‐Kuhnke, M., Wick, W., Hayes, J.M., Pfaff, J. and Pham, M., 2017. Peripheral nerve involvement in multiple sclerosis: demonstration by magnetic resonance neurography. Annals of neurology, 82(5), pp.676-685.
- Samson, K., 2017. In the Pipeline-Multiple Sclerosis: Neurographic MRI Reveals Peripheral Nerve Lesions in MS Patients. Neurology Today, 17(23), pp.9-10.
- Putti, V., 1927. New conceptions in the pathogenesis of sciatic pain. Lancet, 2(July 9), pp.53-60.
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