Dr. Keith Roach

DEAR DR. ROACH: My husband has been totally disabled by sciatic pain for three months. His doctor prescribed 4 mg of methylprednisolone, but it hasn’t done anything to eliminate the pain. He uses a cane. Are there any other things he can do to stop this debilitating pain? — H.B.

ANSWER: The sciatic nerve is the largest nerve in the body (about the size of your finger, only a little flatter). It comes off the spinal cord from the fourth lumbar vertebra through the third sacral vertebra, and provides sensation, motor and reflex innervation to the lower leg and foot region. The term “sciatica” is often used for pain in the foot or leg thought to be due to damage or compression of the sciatic nerve. Many conditions, including disk herniation, spinal stenosis and degenerative disk disease, can cause this.

Sometimes inflammation can exacerbate a chronic issue and cause acute back pain. A powerful anti-inflammatory like methylprednisolone, which is a glucocorticoid (steroid), can reduce inflammation and help the pain. I seldom use this treatment, but it is reasonable in some cases. If it is going to work, it will work within a few days. Long-term treatment with this medication is fraught, with the potential for many side effects including high blood sugar, bone loss, high blood pressure, weight gain and psychosis.

Persistent and disabling symptoms should prompt an evaluation for the underlying cause. Three months is too long to wait. An imaging study, such as an MRI, is indicated to see what could be causing his symptoms.

If his regular doctor is not doing anything more than continuing a treatment that has not helped and has high potential for harm, it is time for another doctor. Experts in sciatica include neurologists, rheumatologists, physical medicine and rehabilitation doctors and, when appropriate, surgeons such as orthopedic surgeons and neurosurgeons.

DEAR DR. ROACH: My husband is 95 and in very good health, although he’s getting frail. Lately, he’s been saying that he occasionally hears singing and sounds of an orchestra at night when he believes he is awake. Have you ever heard of this, and is there a medical explanation for it? — Anon.

ANSWER: I suspect this falls in the category of sleep disorders called hypnagogic and hypnopompic hallucinations. A hallucination is when a person can see, hear or feel things that aren’t there. Unlike a dream, it can be very hard to tell these hallucinations from reality.

Hypnopompic hallucinations happen as a person wakes up, while hypnagogic hallucinations occur as a person falls asleep. Unlike nightmares, which have storylines, hallucinations are usually fairly simple. Visual hallucinations are more common than tactile hallucinations — things you can feel — while auditory hallucinations (like your husband’s) are the least common.

Overall, these hallucinations are fairly common (amazingly, up to 70% of people report having had at least one of these) and do not usually indicate any serious neurological problems. These do occur in some neurological disorders, such as narcolepsy, but I think that is very unlikely in your husband’s case.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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