First off, what is the deal with ortho bros? He was quite knowledgeable, but he walked in with bulging biceps in a tight shirt and I almost started laughing. Live the stereotype, man.
After an exam, he said the L5 disc is pressing on the sciatic nerve. He offered the same injection I had three years ago (computer guided, done at the hospital), but based on what I said, he thought I might be able to get by without one.
I had told him sleep was the biggest variable, as far as I could tell, so he said to add one pillow for my legs (up to two now), which takes pressure off the sciatic nerve and slightly enlarges the passageway for the nerve (something like that, anyway). It's a bit awkward to sleep that way, but nothing I can't get used to.
Plus, he gave me a prescription for gabapentin. He said it interferes with the spinal nerves ability to transmit pain signals, and, as a bonus, it's a slight sedative and it would improve my sleep.
In conjunction with the stretching I'm doing, I'm hopeful all this will manage the situation. Plus I have a referral for physical therapy as well, because I need a system, not a drug. I need to examine my posture and sitting frequency and stretching and everything else to come up with a structure to stop this from happening again.