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Hello and welcome. I am Dr George Lundberg and this is At Large at Medscape.

How is your sciatica today? I say that because 80% of you either now have, have had, or will have the symptoms called "sciatica."[1] Low back pain is the single leading cause of disability worldwide and the second most common reason that American adults go to see their physicians.[1] Not all low back pain is sciatica, but when the pain radiates past the butt, down the thigh, and into the leg, and even to the foot, all on one side, it probably is.

This story is, according to the teachings of many of my Stanford facultymates, the lowest level of evidence of validity—an anecdote. Yet, it is the nature of our tribe to believe our own experiences above almost any other form of evidence.

For more than 2 years, from time to time, I have experienced acute, excruciatingly painful, lancinating, searing, burning, right buttock, thigh, leg, and foot pain. It usually occurs immediately after an uneven, twisting exit from an automobile. I try hard not to perform that movement. Four episodes have been the worst. Symptoms usually disappear over hours or days. Nonsteroidal anti-inflammatory drugs (NSAIDs) have no effect.

In April 2016 I dropped in to my spine doctor's office. I have degenerative cervical spine disease that has been treated successfully with exercise alone. I made an appointment for June to see about my sciatica.

Whoops! On Friday May 6 in San Francisco, I was exiting my wife's SUV and, ooooeee! My back hurt—bad.

When my sciatica hits, hip pain prevents me from placing full standing weight on my right leg. I feel no pain while sitting, lying down, or driving. To relieve the pain and be able to walk requires that I bend forward at the waist at a 90º angle. Then I can walk fine, bent way over, but that places stress on many other body parts and is rather noticeable.

In a required public forum for the next 3 days in May, I toughed it out, but it hurt a lot.

Uninvited, an orthopedist told me bluntly that I probably had foraminal stenosis, needed nerve function measurements, and would probably require back surgery. A woman, unknown to me, urged me to have acupuncture because it worked for her sciatica. This was Saturday afternoon, the day before Mother's Day.

First Treatment Trial: N=1

At 11:00 PM that night, with no improvement, I logged on to Google with my troubles, which sent me to I posted the details of my illness and went to sleep in the hotel. I woke up at my usual 6:00 AM and opened my iPad. In response to my late-night post, a licensed acupuncturist, educated in Chinese medicine at Five Branches University in Santa Cruz/San Jose, California, offered to see me that very morning in San Jose, as long as I could drive the 50 miles in time for her to treat me and still meet her son in Pacifica for Mother's Day brunch.

I met her at 9:30 AM, still walking bent forward at a 90º angle. After 90 minutes of deep massage (including the psoas muscle), multineedle acupuncture, soft music, and Kinesio Taping my lower back over a smelly poultice, I got off the table, stood erect and pain free, and met my large family for Mother's Day brunch.

Three days later, I did an all-day visiting professor gig at University of California, Davis, including presenting grand rounds. After 3 more days, I gave the commencement address at the University of Alabama School of Medicine, all pain free.

I saw my spine doctor in June and told my story. X-rays diagnosed degenerative lumbosacral spondylosis; no treatment recommended; return if more trouble.

Second Treatment Trial: N=1

I had a fine summer. But on Saturday, September 17, 2016, in Oxford, Mississippi, at a football game, I was jumping up and down, screaming, and twisted my back (Alabama 48–Ole Miss 43). Ooooeee! Hurts! (And I do not only mean Alabama quarterback Jalen Hurts.) NSAIDs were no help.

Three days, 2000 air miles, three airports, and seven car rides later, I walked, bent at 90º, into the same San Jose acupuncturist's office. Ninety minutes later, after the same quadruple therapy, I stood erect, pain free, and I walked out fine, to drive myself home. That was 5 days ago. So far, so good.

Do I believe this treatment works? Oh yeah! You better believe I do. Does Medicare or my supplemental Blue pay for it? No, but I am working on that. Maybe some insurer will see this column. Stay tuned.

That is my opinion. I am Dr George Lundberg, at large at Medscape.


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