I feel bad that I didn't see this topic until now because I can actually help with this quite a bit. I've been suffering with this for about 14 months straight. I have 2 herniated discs in lumbar back. The first doc i went to was a physiatrist, who sent me to physical therapy. I thought it helped, but only for a while. At this time he would only prescribe tramadol, which it did work at the time, but I was eating up my stomach with Excedrin and Aleve to get some relief. it kept doing downhill so I started looking for another doc.
I found a pain management doc in Chicago near my work and did get prescriptions for tramadol and hydrocodone. They do urine tests to make sure you are taking your meds and not selling them. They will also not keep prescribing indefinitely unless you are willing to undergo steroid injections. I was in such awful pain and could barely work so I was willing to do anything they asked me to do. Just make sure the doc has an updated MRI, does the injection under flouroscopy and under twilight sedation. I have heard the injections are very painful if done with no sedation. My doc does them at a surgery center so it's an outpatient thing. Each one did give relief anywhere from 1 month to 2 months and the relief I received was great, especially at the beginning since they inject lidocaine in there too. So right when you wake up, you know if they got the exact spot or not. After 2 of them giving relief and then the pain coming back, they suggested consulting with a surgeon. The surgeon got a repeat MRI and looked at it very carefully and called the pain doc and let him know exactly where he thought that herniated material was impinging on the nerve. That third injection gave me the most relief, but the pain did come back after 2 months and then I was headed for surgery. You can only get 3 steroid injections per year. Some pain docs will do 4. They can also do something called a nerve block. I've been warned away from those from an alternative medicine doc because once they deaden one nerve's pain, he said if it comes back, it's very hard to treat because then the pain will become a diffuse pain and it's hard to tell where it's coming from. That made sense to me so I pursued the microdiscectomy instead of pursuing the nerve block treatment.
overall, I think if the pain doc can see on an MRI that you have impingement on the nerve and have a reasonable explanation for your sciatica, they have a few good treatment options and should be willing to treat you, including appropriate pain medicine. I thought my pain doc was wonderful. They never gave me any issue about withholding treatment. I think it helped to let them know all the things I was doing to try to help myself (acupuncture, ex frcise, heat, ice, a million different creams, different cushions, chairs, standing desk). Usually I saw the physician assistant and only saw the pain doc in the operating room for the injections. I thought they were also extremely helpful in helping me find a surgeon when that became necessary because they see the patients afterwards and knew which surgeons had the best results for my procedure. They made me sign a contract so you have to be careful if you "supplement" your regular meds. I believe mine tested only for the presence of opiates and not how much, but I can't be sure.
For sciatica, I thought my PMD was extremely helpful and I am glad I went. I've been told that most bouts of sciatica resolve after a few months, and if it does not, a trip to pain management is essential.
