Nerve pain is among the most intense types of pain. It elicits imagery of electric shock, searing heat, and lightning bolt-like shooting sensations. And, the most feared type of spinal nerve damage is arguably the tell-tale low back and leg pain of sciatica.
A question patients often ask is, “Why is sciatica so painful?” They often believe there’s something unique about sciatica versus other types of spinal nerve pain, but that’s not the case.
Because sciatica involves the sciatic nerve, which is the longest and largest nerve in the body, many assume sciatic nerve compression delivers more pain than other pinched nerves throughout the body. But in 99 percent of sciatica cases, it’s not the sciatic nerve that’s compressed—it’s the nerve roots in the lumbar spine (low back) that combine as they leave the spine and form the sciatic nerve.
When most people refer to sciatica, they describe pain that shoots down the leg following the path of the sciatic nerve, but it’s really one or two nerve roots compromised (typically, the L4 or L5 nerve root). Doctors determine the exact nerve roots that are compressed by the location of the pain, such as if the pain goes down to the big toe or the side of the foot.
Other Sources of the Sciatica Stigma
It affects your legs
One of the reasons sciatica gets so much attention is because the sciatic nerve’s roots feed into the legs, and we use our legs a lot. Patients may perceive sciatica as being more painful than a compressed root in a less active part of your body, such as in the torso. If you compressed or irritated another nerve of equal use or prominence to your leg, it would be just as painful as sciatic pain.
Muscle spasms are the real culprit
Another reason sciatica is associated with intense pain is not related to nerve compression at all: muscle spasms. When a patient with sciatic symptoms is hunched over and can’t stand up straight, that’s a sign the patient has had a back spasm because of the nerve irritation. As sciatica affects your lumbar spine, the muscles that may spasm following nerve damage are the large, postural back muscles. Because these muscles are so large, you’ll feel them when they spasm. On the other hand, if you compress a neck nerve root, you won’t notice a potential muscle spasm quite as much because the muscles near the cervical spine are much smaller. (But spasms of neck muscles can still be very painful!)
Sciatica is a common enemy
The lumbar spine is prone to wear and tear on the intervertebral discs. When this occurs, the discs leak substances that irritate the surrounding nerves. Discs can also herniate, and that can mechanically irritate the nerve. Sometimes, the commonality of sciatica makes it a catch-all diagnosis when a patient doesn’t even have nerve root problem. For example, tweaking your back from lifting is usually a muscular issue, not a nerve issue.
Nerve Pain Is Created Equal
There are many causes of back pain, and sciatica is just one. Sciatica isn’t especially unique when you compare it to other types of nerve pain, as they are all equally detrimental. When nerve pain occurs anywhere in the body, it can be very severe and debilitating. Lives have been turned upside down from nerve pain, so don’t hesitate to see a spine specialist to help relieve nerve pain in your neck or back.