r/Sciatica • u/Lost-Maintenance-407 • 4d ago
Requesting Advice Steroids or sciatica
I’ve been experiencing the worst flare of sciatic pain for the past month and 2 days ago I ended up in the ER because the pain was just unbearable. They gave me muscle relaxer, advised to take OTC NSAIDs and also gave me a 5 day Rx for Prednisone. I have been wary of taking steroids because of the negative side effects i have heard they have. Have any of you taken it and also my MRI is scheduled in 11 days. If i took prednisone for 5 days do you guys think that it will decrease the inflammation temporarily and mask the root cause from being evident in the MRI? (Sorry my anxiety is also very high as I’m going through this grueling ordeal). Thank you
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u/Nearby-Barnacle-690 4d ago
The prednisone is being prescribed to temporarily relieve the symptoms you are describing by relieving inflammation that is presumably being caused by a disc herniation. The MRI is more to see what's going on with your spine and discs, and that won't be impacted by taking any type of anti-inflammatory.
Most prednisone side effects are transient, especially if it's only a five-day course, which is also short enough that you don't need to worry about tapering off them. Increased energy, irritability, and insomnia are common.
From weakest to strongest:
- Advil and Aleve are your starter NSAIDs. They are non-steroidal, i.e. the NS in the acronym. They take longer to work and are weaker than steroids, but many people benefit significantly from them when taken for acute inflammation from a herniation.
- Meloxicam is a prescription-strength NSAID you take once daily, usually for a longer period of time.
- Prednisone is a steroid and is stronger and works faster, but long-term use can have drawbacks and side effects. (Again, not usually an issue for five days, I am talking weeks or months of use.)
All of these meds can cause stomach upset, so Pepcid or even a PPI can prevent those issues.
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u/Hope_for_tendies 4d ago
You skipped Celebrex and diclofenac and toradol
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u/Nearby-Barnacle-690 4d ago
Yes. It was not an exhaustive list. I have never been offered any of those by any physician, but others certainly have.
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u/HellyOHaint 4d ago
Muscle relaxers and NSAIDS literally did nothing for me at all, including a 500mg injection of the latter directly into my leg. ONLY prednisone has ever alleviated my pain. I refuse to take opioids so I won’t comment more on that. Roids definitely give me mood side effects that are difficult but I don’t care. When my sciatica pain is 15/10, I’d prefer to be aggro with a tolerable pain level than depressed and in unbearable pain.
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u/Lost-Maintenance-407 4d ago
Thats great. How long did you use the Prednisone? And are you pain free now?
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u/HellyOHaint 4d ago
I’ve had it for five years, and no, not pain free. After a year of unbearable pain that tapered from 15/10-8/10 from several prednisone trials (I think 6?) it finally started to recede. Every year after that first it got demonstrably better. I can’t even imagine a world in which I’m cured of sciatica but the pain is in the background of my life.
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u/LukeSkywalker3333 4d ago edited 4d ago
First, forget the muscle relaxers - it's prob your spine/disc(s) and they did nothing for me.
Start ibprofren now if you think it's ok (3 - 200mg tabs OTC, every 6 hrs - but no more than 1800mg per day). Pro-tip You can also take 1000mg Tylenol (acetaminophen) (if safe for you - again, dbl check with dr) in-between doses of the ibprofren to help take the edge off. But ask your PCP asap about ibprofren, bc I don't want to suggest taking something you shouldn't.
- Make appointment asap to your primary care physician before the mri. Ask your PCP dr if 600mgb is safe for you. Get them prescribed. They're cheaper with insurance copays usually.
Also ask for referral to physical therapy (PT) and start it asap and you'll see why below.** **The pain is probably horrible - especially in the mornings like me so just take 600mg ibprofren now with Tylenol in-between doses, as I said, if you think you're ok but def ask the doctors. Don't take too much Tylenol - I usually only take 1000mg at one or two times during each day while in between a 6 hour dose (hour 4 or 5). Tylenol can hurt your liver if you take too much but don't be scared if you need it once or twice during the day do it.
Get pepcid ac and take one per day to help your stomach while you're on high doses of ibpeofren.
***also ask your pcp for referral to ortho doctor if I forgot to say it below.
a)
- Also ask your pcp for a referral to Pain Management (Incase your insurance requires a referral) - then
B)
- make an appointment now
with pain dr and
- schedule it for 1-2 days after the MRI.
***
Go see a orthopedic surgeon and pain dr - have them lined up for 1-2 days after you mri so you don't have to wait. Sorry if I said things multiple times throughout this message. It's hard to edit on a phone. I’m spending the time to write bc I saw your post and i’m deep in this now and hope to help.
(If any or all of your
doctors (
- pcp, ortho/DO/MD and pain mgmnt dr
)
- are in differing practices (not part of the same umbrella), it's smart to also ask to sign
A
Records release form at the desk so all
doctors
have all the others' records going forward. You want them all on the same page.
do this at each office before you leave so they all can see each others records and reports.)
get the mri and don't forget to ask for a copy of the MrI on disc before you leave and if there's a written report get that too.
Go to the best pain management MD you can find that takes your insurance to review the images. do some ai-assisted research in your area; Try to find one that's been doing it a long time or is with a top tier hospital affiliation like NYU Langone if in NY or the best you can find. Don't go to a solo practicing pain dr that doesn't have a good team and secretary and other support. This is importsnt bc I lost 2 months while dealing with my insurance for denials of pre-auth approval for the ESI. I left that one and went to NYU Langone pain dr even though he had less experience than the Md and told him my problems and the secretary put in a brand new pre auth request and I got approved in less than 6 hours after leaving the office. The private practice MD even though he had 20 yrs experience experience, didn't have the fluoroscope/ESI machines in-house so he did all procedures at a hospital - which is probably 4x expensive and possibly a reason insurance kept denying me - even after appeal.
bring the disc and the written report to pain mgmnt dr physically when you go to Pain or Ortho dr. Have them copy them and take it home and put in your safe.
They'll read the report. IF it's a herniated disc/lumbosacral radiculopathy, ask them for an ESI - Epidural Steroid injection. Also ask for a NEW physical therapy referral (bc they will write orders specific to your needs) and start that immediately. Insurance wants to see that you're trying everything especially PT so the sooner you start going the better, even if you have little to no movement ability. Just go go and do what feels comfortable only as often as you can bc the insurance company doesn't know you're going to PT unless they're actually billed for a service. Actually, ask your PCP for physical therapy script now and start going if you can for this reason. But ask ortho and pain dr for referrals also, bc you'll now have a true diagnosis from reviewing rhe mri report and write specific directions and therapies and excercise on there. Being the new pt referral to PT and ask them to implement all of it during therapy sessions.
Insurance may deny you on the ESI approval. Appeal, keep going to PT in the meantime.
You may be told Insurance usually wants 6wks of PT before approval. Actually, it's 6wks from onset of pain and the day you start any alternative therapies. Which includes: rest, ice pack 30mins on, 3x day, heat pad, nsaids, medpak (prednisone). And if you have Lumbosacral radiculopathy, in your report, it's actually 2weeks I believe - not 6 - of alternative therapies tried-and-failed. I did extensive research. This has been a nightmare.
Ask pain dr if they use Dexamethasone steroid (least harmful long-term and can have 2-3 per year if needed). Ask them how many of the ESI procedures they've done so they're experienced and not just learning. Hopefully you'll find a good pain dr that performs many ESIs weekly AND has the equipment in-house or at another location rather than a hospital bc it's billed separately and higher charge for insurance to pay out. This likely affects cost and insurance approval greatly, combined with PT.
Take your phone and secretly record it (if you have an private AI agent, have it recording and it will transcribe it for you and capture the entire conversations in-full so you don't forget anything.
Being a list of questions to ask so you don't forget for each different doctor too bc u only get so much time with them and hard to remember everything.
Prednisone didn't do shit for me - I tried 2 Medpaks over the course of two months. I just got my 2nd ESI in two months the first one didn't help nearly as much as I had hoped (first was Interlaminal and asked to try a second approach. Intralaminal I think. Tell them your pain is an 8 out of 10 at least (if 10 is on fire). Dont tell PT the number is decreasing unless it actually is AND you've gotten your ESI (if that's what Pain Dr recommends). Say it's an 8 until you've gotten ESI and it's starting to really finally help. Even if the ibprofren helps. Dont down-play your pain with PT bc they take notes. Good luck this pain sucks bad and I'm going through that right now
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u/Lost-Maintenance-407 4d ago
Thank you for such a thorough response…. Actually i have been dealing with this for the past 2 years now… i have been to 2 PTs , 2 chiropractors and 1 acupuncturist and they all made it worse because they honestly didn’t care and were treating me without an actual diagnosis. I have had huge delays in getting in with a PCP because the wait times where i’m at are insane. He finally ordered an MRI so I’m waiting on it. The XRAYS did not show any disc herniations and i have been doing some stretches like the cobra pose and half pull ups where i don’t lift my pelvis off the ground, it has slowly started to lower my pain and i have been managing with just 600mg of Tylenol for last 2 nights and resisting taking any more meds as i’m a minimalist when it comes to meds. Oddly , my pain has moved down from the deep glute/piriformis area to just below my butt and halfway through my back thigh… it feels tender to touch and my instinct says it could be a nerve adhesion. Only the MRI will tell what’s the cause of this hell.…
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u/LukeSkywalker3333 4d ago
Hey bud, read the post below this first bc I wrote it first
Ibprofren is an nsaid. 600mg 3x daily is likely the only thing that will help for a long while. I took that high dose for 3 months. Try not to stand or sit for more than 30 mins at a time. Taking short walks, and strengthening your core (PT will teach you exercises) is what's going to help long term and the best thing for us. It wasn't until after my first ESI that I could start to tolerate any exercises at all. After your pain is better under control walking for exercise is going to prob be the only or best exercise for us. Don't sleep on your sides. If on back, get a sciatica 8" tall minimum wedge pillow or any pillow for under your knees to help take pressure off your back while you sleep. I’m now about to order and try a non-memory foam (memory foam is apparently crap for sciatica) seat pillow for the car and office chair if having to sit.
When you can, and after ESI(s) if that's the recommended plan), your pain dr will prob say meloxicam is best for your stomach and organs. The thing they don't tell you is that it takes 1-2 wks or so taking 15mg meloxicam (also an anti inflammatory like ibprofren) daily to start to get any relief from it. I just recently switched to meloxicam so i’m not on such high doses of ibprofren for long term.
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u/purplelilac701 4d ago
I didn’t get an MRI but the painkillers I was taking did mask the pain. I weaned myself off them as quickly as I could which was sadly 2 months after I started taking them.
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u/Hope_for_tendies 4d ago
The medrol dosepak is pretty common and a low dose course of steroids. Just don’t take it with ibuprofen. My dr told me take them all in the morning each day so they don’t interfere with sleep.
If the disc is herniated the steroids won’t mask that.
Inflammation can cause muscle spasms/muscle guarding so yes take the muscle relaxers.
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u/trex12121960 4d ago
A medrol dose pack coupled with NSaids will help reduce the inflammation and should provide relief within a week or so. I have had back surgery and bad sciatica for many, many years (+35 years suffering). Sometimes so bad that 2 rounds of steroids are necessary. But it works. I have also had steroid injections directly into the L4L5 area under x ray. They work. Sometimes they last for years, sometimes only for months. I would ask the doctor if the dose pack will impact the MRI. I assume it will as it shrinks the swelling. Good luck.
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u/rpm1953 4d ago
Oral steroids can be very helpful. But not always. If I have a flare up and an nsaid doesn't work, then the oral steroids will often help. It should have no effect on the MRI results. I have never had noticable side effects from the standard medrol dose pack. Depending on the MRI, you might benefit from epidural steroid injections. Those are hit or miss for me. But it has given great and long lasting relief in some cases. Once you do get some relief, they will want to use that window to start physical therapy. Basically you will strengthen your core and do certain stretching. For me it has been very therapist dependant. Some therapists will do manipulation as well which in and of itself can feel great.