Sciatica natural treatment - herbs, vitamins, supplements, inversion therapy 
Does sciatica nerve damage return? Does ankle strength and muscle function come back?
August 23 2018

Natural treatment of sciatica
There are multiple options that I will review.

Sleep on a hard surface rather than a soft mattress.
Avoid prolonged sitting. Most pressure on the low back occurs during sitting and less during standing and even less during walking.
Strengthen your core muscles, your abdominal muscles and your back muscles with different forms of mild exercise.
Lose weigh if you can and if you are carrying extra pounds.
While reading or watching TV lie on the floor instead of sitting.

Inversion therapy benefit -- reverse gravity
If there is bulging or herniation, retraction can occur, theoretically, by applying traction onto the spine which may allow the disc to be “sucked” back in. Inversion therapy is a form of spinal decompression / spinal traction. Use can increase the length of the spine. Gravitational traction has a very apparent effect on lengthening intervertebral space.

Arch Phys Med Rehabil. 1985. Inversion devices: their role in producing lumbar distraction. Improvement of low back symptoms occurred in 13 of the 16 symptomatic patients.

Disabil Rehabil. 2012. Inversion therapy in patients with pure single level lumbar discogenic disease: a pilot randomized trial. We report a pilot prospective randomized controlled trial comparing inversion traction and physiotherapy with standard physiotherapy alone in patients awaiting lumbar disc surgery. Twenty-six patients were enrolled and 24 were randomized [13 to inversion + physiotherapy and 11 to physiotherapy alone (control)]. Surgery was avoided in 10 patients (76%) in the inversion group, whereas it was averted in only two patients (22%) in the control group. Cancellation of the proposed operation was a clinical decision based on the same criteria by which the patient was listed for surgery initially. Intermittent traction with an inversion device resulted in a significant reduction in the need for surgery. A larger multicentre prospective randomized controlled trial is justified in patients with sciatica due to single level lumbar disc protrusions.
   Resolution of impairment and disability due to radiculopathy is the aim of any intervention.• Avoidance of surgery meant satisfactory resolution of impairment and disability due to radiculopathy. This happened more often in the inversion group to the extent of reaching statistical significance. The 12-point improvement in disability by the Oswestry Disability Index in the inversion group suggests a role for this intervention in disability reduction. Inversion may form part of the conservative rehabilitation of patients with single level unilateral lumbar disc protrusion alongside other forms of physiotherapy.

Lumbar traction treatment
Rheumatol Int. 2006. Effect of continuous lumbar traction on the size of herniated disc material in lumbar disc herniation. Lumbar traction is both effective in improving symptoms and clinical findings in patients with lumbar disc herniation and also in decreasing the size of the herniated disc material as measured by CT.

J Manipulative Physiol Ther. 2016. High-Force Versus Low-Force Lumbar Traction in Acute Lumbar Sciatica Due to Disc Herniation: A Preliminary Randomized Trial. Seventeen subjects with acute lumbar sciatica secondary to disc herniation were assigned to high-force traction at 50% body weight or low force traction at 10% BW for 10 sessions in 2 weeks. Radicular pain (visual analogue scale [VAS]), lumbo-pelvic-hip complex motion (finger-to-toe test), lumbar-spine mobility (Schöber-Macrae test), nerve root compression (straight-leg-raising test), disability (EIFEL score), drug consumption, and overall evaluation of each patient were measured at days 0, 7, 1, 4, and 28. For this preliminary study, patients with acute lumbar sciatica secondary to disc herniation who received 2 weeks of lumbar traction reported reduced radicular pain and functional impairment and improved well-being regardless of the traction force group to which they were assigned.

Sciatica with motor loss, my personal story, testimonial of my progression - does nerve damage reverse itself? Can calf strength return? Can sensation in the foot return?
Feb 1, 2018 -- I woke up in the middle of the night with severe low back pain. I had had lingering achiness in my low back for a week and was trying to ignore it and hoping gentle stretches would relieve it. During that week I did not take care of my back well: I helped moved some furniture and clothes for my mom, I sat a lot in front of my computer for hours, and then in my sofa (without good back support( for hours in the evening watching TV, and also went dancing. I am not sure which one of those contributed to the back pain, perhaps they all had their role.
   Anyway I woke up in the morning with even worse pain. I could not walk I sat on the carpet in my bedroom and used my arms to help me move to the bathroom and the kitchen. I megadoses on Aleve (3 pills every 6 hours) and it reduced the pain from 8/10 to 5/10. That evening I still had severe pain when I went to bed. The pain was bad no matter what position I put myself in. Finally I took 0.5 mg of Xanax and decided not to change my position in bed since any movement was making it worse. I awoke in the morning with no pain! However I noticed that the lateral one third of my foot was numb and my calf muscle was weak. I could not raise myself on my toes with just my left foot. No reflex in my left achilles tendon. I diagnosed myself as having sciatica with the L5-S1 nerve being impinged.
   For the next 4 days I took Aleve 3 pills 3 times a day and stopped sine I did not want to cause damage to my hearing and kidneys. The pain did not return but I was still having the foot numbness and waling with a limp since I could not propel myself well with my left leg.

February 21, 2018 -- I resumed 4 pills of Aleve in the evening, but 2 hours later noticed ringing in my ears which concerned my about ear nerve damage from NSAIDs. However, I awoke the next morning and noticed that I could raise my left heel about a quarter inch off the ground. Previously I could not raise it at all.
Feb 22 -- I took 40 mg of prednisone in the morning.
Feb 23 -- took 60 mg prednisone.
Feb 24 -- took 40 mg.
Feb 25 -- took 40 mg. Noticed that I could raise my left heel about half an inch.
Feb 26 -- took a long walk for 3 miles and that evening felt weak in my calf again.
Feb 27 -- Cannot raise my heel, it is a setback. Did I walk too much yesterday? Is too much activity not good to heal from the neuropathy?
March 1 -- It has been a few days that I am taking it easy, just minor stretching and easy yoga. Taking 600 mg naproxen occasionally if I feel that the pain may be starting.
March 5 -- MRI shows L5-S1 disc protrusion.
March 14 -- Had a visit with a physical medicine doctor who did not offer any information that I already did not know. The doctor suggested a surgical referal since I have a loss of my achiles tendon reflex and weakness in my calf muscle.
March 18 - I purchased an inversion table and have been inverting at about a 40 degree level a few minutes several times a day. I also do abdominal crunches while inverted to help strengthen my abdominal muscles.
March 25 - I consulted with an orthopedic doctor who suggested that i do not need surgery even though I have a loss of my left achiles reflex and weaker calf muscle.
March 26 to current day: I have been sitting as little as possible, doing stretches, eating well, doing my daily activities but no additional physical activities. It seems I am a little better.

May 1 - I think I am walking better and can go longer without my calf muscle being tired. I am still doing a 45 degree inversion for 15 minutes once or twice a day.
June 12 - I will guess that I am 20 percent better, it has 4 months since my initial sciatica attack. I am walking a little longer before limping.
July 15 - I am 30 percent better. I try to sit as little as possible. When I watch TV I lie down on the floor. I am walking a mile or two a day. Not doing the inversion therapy anymore. I can raise my left heel, unsupported, for at least an inch and keep it for a while. Feels good to improve.
August 22 - I continue to improve and can walk more than 2 miles without limping.

Sciatica facts
More than 90% of herniated discs occur at the L4-L5 or the L5-S1 disc space, which will impinge on the L4, L5 or S1 nerve root.

Treatment
Lumbar Degenerative disk disease can be treated either conservatively or by surgery. Results of studies have not been consistent. Those with progressive weakness in the muscles require surgical intervention. Neurological deterioration must be avoided as full recovery may be adversely affected.

Exercise -- helpful or hurtful?
Scand J Public Health. 2018. Total sitting time, leisure time physical activity and risk of hospitalization due to low back pain: The Danish Health Examination Survey cohort 2007-2008. Total sitting time was not associated with low back pain or herniated lumbar disc disease. However, moderate or vigorous physical activity, as compared to light physical activity, was associated with increased risk of low back pain

Sciatica treatment studies

Conservative treatment and spontaneous regression of herniated discs and changes in MRI -- does the body take care of the disc protrusion by itself over time?
It has been documented by MRI and CT scans that large discal herniations can regress between 6months to a year. This can occur due to rehidration of the disc, enzymatic degradation of the protrusion.

Orthopade. 1994. Natural course in lumbar disk prolapse. This study reports on 74 patients with lumbar nucleus prolapse (NP) and nerve root symptoms. In all patients the clinical diagnosis was confirmed using a CT-Scan. After 1.7 y a clinical follow-up was performed. Four patients required surgery in the meantime. Ninety percent of the patients treated conservatively experienced marked pain relief and generally appreciated the results of conservative treatment. Nevertheless, 67% had some complaints. The neurological findings showed essential improvement even in cases of severe paresis. Follow-up CT scans performed in 35 of these patients and in a control group of 23 patients showed partial regression of the prolapse at an average of 50%.

Neuroradiology. 2004.Spontaneous resolution of lumbar disk herniation: predictive signs for prognostic evaluation. At MRI follow-up exams at 6 months, spontaneous regression of disk herniation was observed in 35% of cases.

Ann R Coll Surg Engl. 2010. Conservatively treated massive prolapsed discs: a 7-year follow-up. The aim of this study was to investigate whether massive prolapsed discs can be safely managed conservatively once clinical improvement has occurred. Thirty-seven patients were studied by clinical assessments and serial magnetic resonance imaging (MRI) over 2 years. Patients had severe sciatica at first, but began to show clinical improvement despite the large disc hernia-tions. Clinical assessment included the Lasegue test and neurological appraisal. The Oswestry Disability Index was used to measure function and changes in function. Serial MRI studies allowed measurement of volume changes of the herniated disc material over a period of time. Initial follow-up at an average of 23 months revealed that 83% had a complete and sustained recovery. Only four patients required a discectomy. The average Oswestry disability index improved from 58% to 15%. Volumetric analysis of serial MRI scans found an average reduction of 64% in disc size. There was a poor correlation between clinical improvement and the extent of disc resolution. A massive disc herniation can pursue a favorable clinical course. If early progress is shown, the long-term prognosis is very good and even massive disc herniations can be treated conservatively.

Spine (Phila Pa). 2017. Do MRI Findings Change Over a Period of Up to 1 Year in Patients With Low Back Pain and/or Sciatica?: A Systematic Review. The aim of the study was to investigate whether magnetic resonance imaging (MRI) findings change over a relatively short period of time (<1 yr) in people with low back pain (LBP) or sciatica. This review found moderate evidence that the natural course of herniations and nerve root compression is favorable over a 1-year period in people with sciatica or LBP. There is a lack of evidence whether changes in MRI findings are associated with changes in clinical outcomes.

Korean J Pain. 2017. Lumbar herniated disc: spontaneous regression. To evaluate and present the therapeutic outcomes in lumbar disc hernia patients treated by means of a conservative approach, consisting of bed rest and medical therapy. It should be kept in mind that lumbar disc hernias could regress with medical treatment and rest without surgery, and there should be an awareness that these patients could recover radiologically.

Pain Physician. 2017. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis. We analyzed the incidence of spontaneous resorption after conservative treatment of LDH using computed tomography and magnetic resonance imaging. Our results represent the pooled results from 11 cohort studies. The overall incidence of spontaneous resorption after lumbar disc herniation was 66%. The incidence in the United Kingdom was 82%. The incidence in Japan was 62%.

Chiropractic treatment
Although many people benefit from visits to a chiropractor, adverse effects are possible.

Zhongguo Gu Shang. 2017. Clinical characteristics analysis of lumbar disc herniation with symptom aggravation caused by spinal manipulative therapy. Spinal manupulation should be prohibited in some lumbar disc herniation patients to prevent neurological damages.

Duration of symptoms and signs of sciatica
Spine J. 2017. Prognosis of sciatica and back-related leg pain in primary care: the ATLAS cohort. A total of 609 patients were included. At 12 months, 55% of patients improved in both the total sample and the sciatica group.

Epidural steroids
Ann Intern Med. 2013. ACP Journal Club. Review: epidural corticosteroids reduce short- but not long-term leg pain and disability in sciatica.

Prescrire Int. 2015. Sciatica and epidural corticosteroid injections. According to trials conducted in hundreds of patients with sciatica, epidural corticosteroid injections have no efficacy beyond the placebo effect, either in the short-term or the long-term. However, they expose patients to occasional serious neurological adverse effects.

Lifestyle factors -- smoking, obesity, exercise 
Spine (Phila Pa 1976). 2015. Advice to Stay Active or Structured Exercise in the Management of Sciatica: A Systematic Review and Meta-analysis. There is low-quality evidence that exercise provides small, superior effects compared with advice to stay active on leg pain in the short term for patients experiencing sciatica. However, there is moderate-quality evidence showing no difference between advice to stay active and exercise on leg pain and disability status in people with sciatica in the long term.

Am J Med. 2017. Lifestyle Risk Factors Increase the Risk of Hospitalization for Sciatica: Findings of Four Prospective Cohort Studies. Smoking and obesity increase the risk of hospitalization for sciatica, whereas walking or cycling to work protects against hospitalization for sciatica.

Physically demanding work is a strong risk factor for sciatica. Leisure-time physical activity seems to protect against sciatica, while being overweight is a risk factor.

Lumbar traction
J Manipulative Physiol Ther. 2016. High-Force Versus Low-Force Lumbar Traction in Acute Lumbar Sciatica Due to Disc Herniation: A Preliminary Randomized Trial. For this preliminary study, patients with acute lumbar sciatica secondary to disc herniation who received 2 weeks of lumbar traction reported reduced radicular pain and functional impairment and improved well-being regardless of the traction force group to which they were assigned.

Nerve loss -- muscle weakness. motor deficit, and loss of sensation
Spine (Phila Pa). 2002. A pilot study on the recovery from paresis after lumbar disc herniation. Although the existence of a motor defect in discogenic sciatica is a sign of severity, the literature does not provide evidence for an immediate requirement for surgery. To assess the course of sciatica with discogenic paresis and to determine possible prognostic factors for recovery or improvement. This open prospective multicenter study included patients with discogenic sciatica with paresis that had been developing for less than 1 month and was rated < or =3 on a 5-grade scale. This 6 month study showed no difference between surgical or medical management for recovery or improvement in patients with discogenic paresis.

Eur Spine J. 2013. The prognosis of self-reported paresthesia and weakness in disc-related sciatica. Patients with sciatica were followed to determine the course of paresthesia (tingling and numbness) and weakness as compared with leg pain during 2 years of follow-up. Those who received surgery reported larger improvements in both symptoms than did those who were treated without surgery. At 2 years follow up, less than 20 percent still had symptoms.

Spine J. 2014. Recovery of motor deficit accompanying sciatica--subgroup analysis of a randomized controlled trial. In patients with sciatica due to a lumbar disc herniation, it is generally recommended to reserve surgical treatment for those who suffer from intolerable pain or those who demonstrate persistent symptoms after conservative management. Controversy exists about the necessity of early surgical intervention for those patients that have an additional motor deficit. The aim of this study was to compare the recovery of motor deficit among patients receiving early surgery to those receiving prolonged conservative treatment. The subgroup analysis focuses on 150 (53%) of 283 patients with sciatica due to a lumbar disc herniation and whose symptoms at baseline (before randomization) were accompanied by a motor deficit. In total, 150 patients with 6 to 12 weeks of sciatica due to a lumbar disc herniation and whose symptoms were accompanied by a moderate (MRC Grade 4) or severe (MRC Grade 3) motor deficit were randomly allocated to early surgery or prolonged conservative treatment. Sciatica recovered among seven (10%) of the 70 patients assigned to early surgery before surgery could be performed, and of the 80 patients assigned to conservative treatment, 32 patients (40%) were treated surgically because of intolerable pain. Baseline severity of motor deficit was graded moderate in 84% of patients and severe in 16% of patients. Motor deficit recovered significantly faster among patients allocated to early surgery, but the difference was no longer significant at 26 or 52 weeks. At 1 year, complete recovery of motor deficit was found in 81% of patients allocated to early surgery and in 80% of patients allocated to prolonged conservative treatment. Perceived overall recovery of sciatica was directly related to the presence of an accompanying motor deficit. Severe motor deficit at baseline and a lumbar disc herniation encompassing ≥25% of the cross-sectional area of the spinal canal were the most important risk factors for persistent deficit at 1 year. Early surgery resulted in a faster recovery of motor deficit accompanying sciatica compared with prolonged conservative treatment but the difference was no longer significant during the final follow-up examination at 1 year.

Oral steroids
JAMA. 2015. Oral steroids for acute radiculopathy due to a herniated lumbar disk: a randomized clinical trial.  Adults with radicular pain for 3 months or less, an Oswestry Disability Index (ODI) score of 30 or higher (range, 0-100; higher scores indicate greater dysfunction), and a herniated disk confirmed by magnetic resonance imaging were eligible. Participants were randomly assigned to receive a tapering 15-day course of oral prednisone (5 days each of 60 mg, 40 mg, and 20 mg; total cumulative dose = 600 mg) or matching placebo. Among patients with acute radiculopathy due to a herniated lumbar disk, a short course of oral steroids, compared with placebo, resulted in modestly improved function and no improvement in pain.

Surgery or conservative therapy - which is better and safer?
Send to BMJ Open. 2013. Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial. There were no significant differences between groups on the 5 years' primary outcome scores. In the long term, 8% of the patients with sciatica never showed any recovery and in at least 23%, sciatica appears to result in ongoing complaints, which fluctuate over time, irrespective of treatment. Prolonged conservative care might give patients a fair chance for pain and disability to resolve without surgery, but with the risk to receive delayed surgery after prolonged suffering of sciatica. Age above 40 years, severe leg pain at baseline were predictors for unsatisfactory recovery.

Med Glas (Zenica). 2013. Low back and lumbar radicular syndrome: comparative study of the operative and non-operative treatment. We performed a study enrolling 100 patients. According to our extended criteria all of them had operative indications. We operated 50 patients, 50 patients refused operation and they were treated non-operatively. Treatment results were in favor of surgery A fast reduction of symptoms is the main advantage of the operative treatment strategy. Patients whose pain is controlled in a manner that is acceptable for them may decide to postpone surgery.

Send to Spine (Phila Pa 1976). 2014. Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the spine patient outcomes research trial. Carefully selected patients who underwent surgery for a lumbar disc herniation achieved greater improvement than nonoperatively treated patients.

Curr Pain Headache Rep. 2014. Conservative treatments for lumbar radicular pain. Surgery may only be necessary in the event of pain persisting in excess of 3 months or because of the development or worsening of a neurologic deficit.

Clin Orthop Relat Res. 2015. What Are Long-term Predictors of Outcomes for Lumbar Disc Herniation? A Randomized and Observational Study. Although previous studies have illustrated improvements in surgical cohorts for patients with intervertebral disc herniation, there are limited data on predictors of long-term outcomes comparing surgical and nonsurgical outcomes. Results showed no difference over 8 years for primary outcomes of overall pain, physical function, and back-related disability but did show small advantages for secondary outcomes of sciatica bothersomeness, satisfaction with symptoms, and self-rated improvement. Subgroup analyses identified those groups with sequestered fragments on MRI, higher levels of baseline back pain accompanying radiculopathy, a longer duration of symptoms with a greater relative advantage from surgery at 8 years.

Spine J. 2016. Does the duration of symptoms influence outcome in patients with sciatica undergoing micro-discectomy and decompressions? Early surgical treatment for back and leg pain secondary to disc herniation has been associated with good outcomes. However, there are conflicting data on the role of surgical treatment in case of prolonged radicular symptomatology. Our study showed significant improvement in patients with symptoms beyond 1 as well as 2 years since onset, and surgery is a viable option in selected patients.

Spine J. 2016. A systematic review of preoperative predictors for postoperative clinical outcomes following lumbar discectomy. Sciatica is often caused by a herniated lumbar intervertebral disc. When conservative treatment fails, a lumbar discectomy can be performed. Surgical treatment via lumbar discectomy is not always successful and may depend on a variety of preoperative factors. It remains unclear which, if any, preoperative factors can predict postsurgical clinical outcomes. Preoperative predictors associated with positive postoperative outcomes included more severe leg pain, better mental health status, shorter duration of symptoms, and younger age. Preoperative predictors associated with negative postoperative outcomes included intact annulus fibrosus, longer duration of sick leave, worker's compensation, and greater severity of baseline symptoms. Several preoperative factors including motor deficit, side and level of herniation, presence of type 1 Modic changes and degeneration, age, and gender had non-significant associations with postoperative clinical outcomes.

Eur J Pain. 2016. Patients with sciatica still experience pain and disability 5 years after surgery: A systematic review with meta-analysis of cohort studies. The clinical course of patients with sciatica is believed to be favourable, but there is conflicting evidence on the postoperative course of this condition. Although surgery is followed by a rapid decrease in pain and disability by 3 months, patients still experience mild to moderate pain and disability 5 years after surgery.

Eur Spine J. 2016. Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis. Previous reviews have compared surgical to non-surgical management of sciatica, but have overlooked the specific comparison between surgery and physical activity-based interventions. Long-term and greater than 2-year post-randomisation results favoured surgery for spondylolisthesis and stenosis, although the size of the effects reduced with time. For disc herniation, no significant effect was shown for leg and back pain comparing surgery to physical activity.

BMJ Open. 2016. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. Compared with conservative therapy, surgical treatment provided faster relief from back pain symptoms in patients with lumbar disc herniation, but did not show a benefit over conservative treatment in midterm and long-term follow-up.

Lumbar Degenerative Disk Disease. 2017. Donnally III CJ1, Dulebohn SC2. If the disc injury progresses to the point of neurologic compromise or limitations with activities of daily living, then surgical intervention may be required to decompress and stabilize the affected segments. In the absence of motor deficits, a nonoperative course of analgesia, activity modification, and injections should be tried for several months. The surgical results for the primarily sciatic pain that has failed conservative treatment are favorable.

Timing of surgery
Spine (Phila Pa 1976). 2017. Immediate versus Delayed Surgical Treatment of Lumbar Disc Herniation for Acute Motor Deficits: The Impact of Surgical Timing on Functional Outcome. The aim of the study was to assess the impact of time to surgery in patients with MDs on their functional outcome. The current single-center study presents results of emergency surgery for LDH in a group of patients with acute paresis in a "real-world" setting. Motor deficits (MDs) are a frequent symptom of lumbar disc herniation (LDH). While surgery within 48 hours has been recommended for cauda-equina syndrome, the best timing of surgery for acute MDs continues to be debated. 330 patients with acute paresis due to LDH acutely referred to our department and surgically treated using microsurgical discectomy were included. Based on the duration of motor deficits and surgical timing, all patients were classified into two categories: Group I included all patients with a paresis <48 h and Group II >48 h. Severity of paresis (MRC 0-4), surgery-related complications, functional recovery of motor/sensory deficits, sciatica, retreatment/recurrence rates, and overall neurological outcome were analyzed. Group I showed significantly faster recovery of moderate/severe paresis (MRC 0-3) at discharge, and 6-weeks/3-months follow-up, while there were no significant differences in recovery for mild paresis (MRC 4). Sensory deficits also recovered substantially faster in Group I at 6-weeksand 3-months follow-up. BMI, preoperative MRC-grade and duration of MDs were identified as significant predictors for recovery of paresis. Given the superior rates of neurological recovery of acute moderate/severe MDs, immediate surgery should be the primary option. Yet, a prospective randomized clinical trial is needed to confirm the superiority of emergency surgery.

Dietary supplements for neuropathic pain
Minerva Ginecol. 2015. Use of alpha-lipoic acid and omega-3 in postpartum pain treatment. Postpartum pain is a frequent condition that negatively affects women's quality of life, interferring with everyday life. Analgesic drugs and surgery are often contraindicated in pregnancy and during breast feeding. This review of the literature aims to evaluate the rational of the association of lipoic acid and omega-3 employ in the management of postpartum pain. Lipoic acid is a cofactor essential in mitochondrial metabolism with antioxidant and anti-inflammatory activity. Lipoic acid has been shown to be effective in neuropatic pain treatment in patients with sciatica, carpal tunnel syndrome and diabetic neuropathy. Omega-3 are known for their anti-inflammatory and neurotrophic activity. The peripheral and central activity of both substances allows to act on neuroinflammation mechanisms thus reducing cronicization of pain and also determining a potential improvement of women's emotional status. The preliminary data here presented confirm the positive effect of this association on the treatment of postpartum perineal pain. The supplementation of lipoic acid in association with omega-3 seems effective and safe for the treatment of chronic postpartum pain, allowing a pathogenetic approach to neuroinflammation, thus reducing the consumption of analgesic drugs, often contraindicated during breast-feeding.