Seeking a second opinion on sciatica is important before acquiescing to any type of treatment program. This is because sciatica is certainly one of the most misdiagnosed of all dorsalgia conditions. In fact, if any doctor or chiropractor diagnoses you with sciatica, you are already off to a terrible start in finding relief. Sciatica is never a condition unto itself, but instead, is always a symptom of a spinal structural causation.
Additionally, since the pain must be spinally-motivated, many patients are also incorrectly labeled as suffering from sciatica, when they are actually afflicted with pseudo-sciatica from a nonspinal origin.
Diagnostic explanations for sciatica are often off base, while treatment recommendations are even more confusing. All of these factors make it absolutely critical to seek multiple opinions on the cause and cure for the current symptom set before taking any definitive action.
This essay helps patients to understand how and why to seek multiple opinions regarding their sciatic nerve symptomologies.
As mentioned above, if a patient is diagnosed with sciatica, then they already have a big problem. Sciatica is never a separate diagnosis. It is merely an expression of some underlying condition. Doctors who do not understand this should already be raising red flags with their patients.
Even when this misuse of nomenclature is not a problem, discovering the true source of sciatica symptoms can be a real challenge. There can be spinal problems that might cause true sciatica. There can also be nonspinal problems that might cause pseudo-sciatica.
Spinal causations can include intervertebral herniation affecting one or more of the cauda equina nerve roots, central spinal stenosis affecting one of more of the cauda equina nerve roots or any other structural concern, such as atypical spinal curvature or vertebral alignment that can affect one or more of the cauda equina nerve roots.
Alternate non-lumbar spinal causations might include cervical spinal stenosis that affects the spinal cord and leads to lower body symptoms that mirror true sciatica, even though these qualify as pseudo-sciatica.
Meanwhile, pseudo-sciatica can be caused by a neurological abnormality in the fully formed ischiatic nerve, compression of the sciatic by the piriformis muscle or localized injury to the ischiatic nerve.
Believe it or not, this is actually a greatly simplified list of only the most common causes of sciatica pain syndromes. Statistics clearly demonstrate that achieving an accurate diagnosis of the true cause of sciatica symptoms is extremely difficult. This explains why multiple opinions have a greater chance of identifying the actual source process, compared to a "theory" suggested by any single care provider.
If multiple diagnostic opinions generate different verdicts, then the patient must continue to research the origins of their pain before seeking therapy. However, if multiple opinions agree on the causation, this increases the chances of successful diagnosis and will lead to better treatment outcomes.
Once a diagnosis has been verified and accepted, patients must now consider their many treatment options. Once again, doctors and complementary caregivers are likely to each have individual recommendations on the best course of action.
Finding the ideal treatment takes some effort on the patient’s part, since they must consult with their multiple diagnosticians and compare treatment prescriptions on many levels. No one wants to suffer through an expensive, lengthy or invasive treatment if it can be avoided.
It should be no surprise that the treatments recommended from each doctor will certainly include therapies that are offered by that specific provider. In essence, in virtually every case, chiropractors will recommend chiropractic; physical therapists will advise physical therapy and surgeons will tend towards surgical prescriptions. Now, the patient has an even greater burden placed upon them. They must not only evaluate and compare each treatment against the others, but they must also consider how the economics of medical care have influenced their diagnosticians in their recommendations for care.
During diagnostic evaluation, patients can become confused and frustrated, especially when they receive many contrasting verdicts on the exact nature and causation of their pain. There has been much written on this website about diagnostic eclecticism and how this occurrence usually means that no doctor really truly knows why a patient has pain. This is a very scary thought to ponder, but it is 100% true.
When it comes to treatment, separating objective advice from financial opportunism can be tough. Unfortunately, so many patients do not even consider the monetary motivations of their providers when thinking about the best path towards a successful cure. In many instances, this naivete results in an unnecessary large monetary investment, extended care without a cure or an unneeded surgical ordeal that may have lifelong consequences to health and physical functionality. So many readers write to us saying that they have suffered all three of these terrors.
We advise that sciatica is indeed one of the most difficult of all chronic pain syndromes to accurately diagnose, and even when the diagnosis is sound, treatment might still be challenging. It is for these very reasons that we continue to caution patients to take increasingly active roles in their own care and research all their options thoroughly before acting on any diagnostic theory or therapy recommendation offered by a single caregiver.