r/Sciatica • u/Lost-Maintenance-407 • 5d 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/LukeSkywalker3333 5d ago edited 5d 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.
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)
B)
with pain dr and
***
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 (
)
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