I’m suffering with an excruciatingly painful bout of sciatica. Painkillers and amitriptyline make no difference. I can’t even put my foot on the ground it’s so bad. I’ve heard there are injections people can get – is this true?
Dr Ellie replies: Sciatica is a debilitating pain condition which requires careful management from a doctor.
It occurs when the sciatic nerve in the spine becomes squashed, usually because of back problems. Since this nerve travels down the leg it causes pain in the back or buttocks, as well as the back of the leg.
It can also lead to numbness and tingling in those areas.
There are many conditions which have similar symptoms but require different treatment. These include arthritis, spinal fractures and, rarely, cancer.
For this reason, it’s important that patients see their doctor for an examination and diagnosis. This is the case even for patients who have had sciatica in the past.
Sciatica is when the sciatic nerve in the spine becomes squashed, usually because of back problems
It is rare that sciatica patients will be offered back injections. These steroid jabs are sometimes given to people with long-term back problems, but the evidence to support their use is not strong.
Instead, there is a collection of treatment that GPs can offer sciatica patients. Individually, these cannot solve the problem completely. But used together they can make a real difference to the pain and lack of mobility patients experience.
These include simple painkillers like paracetamol, anti-inflammatory drugs such as naproxen, and codeine-based medicines (used sparingly) for when the pain is particularly bad.
Nerve pain drugs, such as amitriptyline or nortriptyline, can also have a really positive impact on sciatica pain.
However, they can take several weeks to kick-in, so patients need to keep taking them even if they don’t initially experience any improvement.
However, sciatica cannot be treated with medicine alone. Most patients will need physiotherapy to help restore mobility to the affected areas.
A GP can provide a referral to a physio and, in many areas of the country, patients can self-refer. There is also an NHS-recommended website where patients can find exercises to do, called backcare.org.uk.
I’ve had small ring-shaped patches on my hands for months now. They don’t itch and don’t appear anywhere else on my body. Steroid creams don’t work and my doctor has no clue what to do. What do you think?
Dr Ellie replies: Ring-shaped patches on the back of the hands may be a condition called granuloma annulare. Usually, its accompanied with red bumps. The back of the hands is the most common location for these marks, but they can also occur on the chest, tummy and back.
Doctors still don’t know what causes the condition, but it is thought to be due to inflammation in one of the deeper layers of the skin. It appears to be more common in people with diabetes.
The good news is that, most of the time, granuloma annulare will fade and disappear on its own. However, for some, this can take years, which is why there are treatments available on the NHS. These include steroid creams, UV light therapy and a skin-freezing technique called cryotherapy.
Treatment for granuloma annulare can only be carried out by a dermatologist. This means patients need to get a referral from their GP first.
Another possible cause of circular-shaped marks on the skin could be a fungal infection called ringworm.
However, ringworm usually triggers itchy skin. The rash also tends to grow and spread.
I recently had a tooth extracted and my gum isn’t healing. My dentist said it could be due to an osteoporosis medicine I used to take called fosamax. But no one warned me of this before the surgery. Could this be true?
Dr Ellie replies: Fosamax, also known as alendronic acid, is a treatment for the bone-thinning condition osteoporosis. The weekly tablet prevents fractures but, in very rare cases, can trigger jaw damage. This problem, called osteonecrosis, can weaken the gums and slow healing in the mouth.
While the vast majority of fosamax patients won’t get osteonecrosis, doctors normally advise them to get dental work done before the treatment for this reason. Moreover, even after stopping fosamax, patients can still experience this issues years later.
A dentist, not a GP, can diagnose osteonecrosis after an examination. They can then refer patients to a specialist who can provide treatment including antibiotics, which appear to help the healing process, and painkillers to manage any pain.
In most cases, these wounds heal, but this can take up to a year. Good dental hygiene will speed up the healing process.
However, osteonecrosis is not the only cause. Recent chemotherapy can have this effect. So can poor dental health.
- Do you have a question for Dr Ellie Cannon? Email [email protected]k.
- Dr Cannon cannot enter into personal correspondence and her replies should be taken in a general context.
Do you love or loathe butter?
People seem to feel very strongly about butter and oil. Have you heard the phrase ‘the hateful 8’, used to describe
the list of seed oils – including sunflower – that are supposedly bad for you?
I hadn’t, until a patient told me about it recently.
This chap told me he always opted for butter or animal fat such as beef dripping, as it’s more natural and has been in our diet for so long.
Others feel the opposite and are big margarine fans.
It’s actually a huge area of debate. What we do know is that all dietary fats – butter or seed oil – contribute to cholesterol levels. Seed oils contain fewer saturated fats, which raise levels of bad cholesterol in the body and contribute to heart disease.
But ultra-processed foods, which are increasingly linked to ill health, are full of seed oils. What do you think? Are you a butter lover or loather?
No wonder Daisy has looked to alternatives
Daisy Knatchbull, the third cousin of Prince William, use a chakra cleanse to cure her gynaecological problems
I was baffled to read last week about Daisy Knatchbull, the third cousin of Prince William, who claims to have cured her gynaecological problems by standing on her head and drinking herbs.
Apparently doing this was part of something called a chakra cleanse.
Obviously it’s complete rubbish, but she does have one sensible point to make. Daisy says she was given no answers from conventional medics for her condition, polycystic ovary syndrome, and she’s not wrong.
The lifelong problem causes irregular periods and weight gain, as well as fertility issues.
One of the best treatments is a low carbohydrate diet, but otherwise we only have medications that treat the symptoms, not the underlying problem.
Frankly, I’m not surprised women look elsewhere.
