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TITLE OF CASE

Successful standalone ayurvedic management of Sciatica- A case report

Dr Ajayan

ABSTRACT

A 62-year-old patient was suffering from pain in the low back region for 10 years (2012). He tried home remedies for some time, but the pain persisted. 3 years later he developed numbness in the bilateral lower limbs. MRI of LS spine confirmed the biomedical diagnosis as Sciatica (2015) [1]. He consulted Allopathic doctors and underwent traction, took injections and oral medications. He would get temporary relief and the symptoms would relapse again. He even tried physiotherapy for 10 days. As he was not satisfied with the outcomes, he consulted Dr Ajayan. The Ayurvedic diagnosis was Gridhrasi. [2] The line of treatment followed was dipana, pacana, vatahara and to pacify pain. After 2 weeks of ayurvedic treatments, the patient got complete relief from low back pain. SLR in the right and left before treatment was 40 degrees with pain. After treatment, SLR was recorded at 70 degrees on the left without pain, and negative on the right. There was no radiating pain and the numbness reduced significantly. All the medicines were stopped, and the patient is in remission.

KEYWORDS

Gridhrasi, sciatica, case report, SLR

INTRODUCTION

Sciatica is a debilitating condition that is a result of the sciatic nerve or sciatic nerve root pathology. Affected patients experience pain and paraesthesia in the sciatic nerve distribution or an associated lumbosacral nerve root. Sciatica pain often is worsened with twisting, bending, or coughing.

Causes:

Any condition that may structurally impact or compress the sciatic nerve may cause sciatica symptoms. The most common cause of sciatica is a herniated or bulging lumbar intervertebral disc. Lumbar spinal stenosis in elderly people, spondylolisthesis, lumbar or pelvic muscular spasm and/or inflammation, spinal or paraspinal mass including malignancy, epidural hematoma, or epidural abscess may also cause a mass-like effect and sciatica symptoms.

Diagnostic criteria:

Sciatica is a clinical diagnosis, and therefore, a thorough history and physical examination are necessary for a complete evaluation and diagnosis. Additionally, pain that has been persistent for 6 to 8 weeks and not responding to conservative management should be imaged.

Treatment:

This is often a chronic condition that is managed through the use of analgesics to control the pain and NSAIDs to decrease inflammation. Surgery is opted, once the conservative methods fail. In this patient, the symptoms have been persisting since 10 years. Over the years, he tried conventional medicine and physiotherapy, but got only temporary relief.

Prognosis:

Most cases of sciatica resolve in less than 4 to 6 weeks with no long-term complications even if no medical therapy is sought. In more severe cases or cases where the neurologic deficit is present, the patient may have a more prolonged course of recovery. However, recovery is still excellent.

PATIENT INFORMATION

A 62-year-old male patient was suffering from pain in the low back region for 10 years (2012). He tried home remedies for some time, but the pain persisted. Three years later he developed numbness in the bilateral lower limbs. MRI of the LS spine confirmed the biomedical diagnosis as Sciatica (2015).

Medical History: The complaints of low back pain started 10 years ago. He had done home remedies, but the pain persisted. Three years later he developed numbness on the bilateral lower limb. He consulted allopathic doctors and underwent traction, injection, and medications. For 3-4 months the patient got some relief, but the condition would relapse again. In February 2022, he tried physiotherapy for 10 days. He got only temporary relief. So in March 2022, he consulted Dr Ajayan for better management of the condition.

CLINICAL FINDINGS/PHYSICAL EXAMINATION

Low back:

Flexion and extension- possible with pain. Lateral flexion, extension- possible SLR: Right - positive at 40 degree Left- positive at 40 degree. Crepitus on knee joint: present on bilateral lower limb

TIMELINE

Image1. TIMELINE of events to be added

DIAGNOSTIC ASSESSMENT

Modern Diagnostic parameter: The biomedical diagnosis was made based on clinical presentation and examination. This was confirmed with MRI spine done in 2015 and at baseline 2022.

Image 2. MRI spine (old report) dated 2015 added below

Image 3. MRI spine dated 2022 added below

Ayurvedic Assessment was done based on the investigation reports and the clinical evaluation by the ayurvedic physician.

Differential Diagnosis- The diagnosis was confirmed with MRI spine dated 2015 and 2022.

Prognosis- Most cases of sciatica resolve in less than 4 to 6 weeks with no long-term complications even if no medical therapy is sought. In more severe cases or cases where the neurologic deficit is present, the patient may have a more prolonged course of recovery. In this patient in spite of taking the modern line of management in the form of oral medicines, injections, and physiotherapy the condition persists and became progressive in nature. After 3 weeks of ayurveda treatment, the low back ache was relieved, numbness was reduced with no radiating pain in the lower limbs.

THERAPEUTIC INTERVENTION

See the tab ‘Treatment details

FOLLOW-UP AND OUTCOMES

Clinician-based assessment; The SLR, flexion and extension of low back was used as the assessment criteria in this patient. The repeat MRI could not be done owing to the cost.

Table 1. Assessments recorded before, during and after treatment added below

Patient assessed: Not relevant

Adherence and tolerability – The patient adhered to the prescribed treatments and tolerated the treatments well.

Method of assessment- By monitoring the patient.

Adverse and unanticipated events; None reported.

DISCUSSION ;

As Gridhrasi is a vata nanatmaja vyadhi, the main target was to pacify the vitiated vata. Here the physician explains the rationale for each medicine selected.

Maharasnadi Kasaya- to address the pain

Abhayaristam- for pacana

Hinguvachadi curnam- for agnidipana

Yogaraja guggulu- Is vatahara

Satahwadi taila- to address the pain.

PATIENT’S PERSPECTIVE

Not available.

LEARNING POINTS/TAKE-HOME MESSAGES

The case report illustrates the utility of ayurveda concepts and the efficacy of ayurvedic medicines in treating a chronic case of sciatica that was not giving satisfactory outcomes with conventional management.

INFORMED CONSENT

Written consent was obtained from the patient to publish the case report.

CONFLICT OF INTEREST

None declared.

FUNDING

None

REFERENCE

1. Ropper AH, Zafonte RD. Sciatica. N Engl J Med. 2015 Mar 26;372(13):1240-8. doi: 10.1056/NEJMra1410151. PMID: 25806916. Raff AB, Kroshinsky D. Cellulitis: A Review. JAMA. 2016 Jul 19;316(3):325-37.
2. Sathavane GV, Pandya DH, Baghel MS. Effect of Vatari Guggulu in the management of Gridhrasi (sciatica). Ayu. 2015 Jan-Mar;36(1):41-5.

Image 1. Timeline 

Image 2. MRI spine (old report) dated 2015

Image 3. MRI spine dated 2022

Table 1. Assessments recorded before, during and after treatment

Assessments	Before treatment (16/3/22)	During treatment (1/4/22)	After treatment (7/4/22)
SLR	Positive at 400bilateral	Left- positive at 600, slightly painful Right- negative, could raise without pain	Left- positive at 70 degree without pain                          Right- Negative.
Low back- Flexion and extension	Painful	Possible- with mild pain	Possible- with no pain