Q: I would like to know the treatment for sciatica associated with pregnancy,whether NSAIDS can be used,if yes which group is preferred? Further, can opiod drug tramadol which is also used for painless labour be used to abate the pain?
A:First of all I would like to clarify that sciatica as such is not a diagnosis. Sciatica is a symptom complex (a combination of symptoms) where patient has pain radiating from the back to the back of thigh or even calf. This could be as a result of several clinical conditions. Most common among these in a younger patients is a prolapsed intervertebral disc and in an older patient as a result of spondylosis (degeneration of the spine that occurs with age). Backache with pain radiating to the back of thigh is fairly common in pregnancy and the usual cause is sacro-iliac joint (this joint is a large joint at the back of pelvis) ligament relaxation that normally occurs during pregnancy.Normal day to day activities may put abnormal stresses on the relaxed joint causing pain. Relaxation is essential requirement for preparing the pelvis to facilitate normal delivery.This kind of back pain can be taken care of by adequate rest between activities of daily living and exercises to build up pelvic and back muscles before pregnancy advances to the later stages.It is not advisable to take any NSAIDs during pregnancy. If pain is very severe you could try oral paracetamols 3 to 4 times a day.Opioid analgesics are safer in not producing congenital problems but tend to cause dependency (addictions) and constipation. In fact, straining at stools because of constipation might actually worsen backache. Opioid analgesicsgiven closure to delivery time may cause depression of the babys respiratory effort. Any way these must not be taken without careful medical supervision.