Radicular pain
Encyclopedia
Radicular pain, or radiculitis, is pain
"radiated" along the dermatome
(sensory distribution) of a nerve
due to inflammation or other irritation of the nerve root
(radiculopathy
) at its connection to the spinal column. A common form of radiculitis is sciatica
– radicular pain that radiates along the sciatic nerve
from the lower spine to the lower back, gluteal muscles, back of the upper thigh, calf, and foot as often secondary to nerve root irritation from a spinal disc herniation
or from osteophytes in the lumbar
region of the spine.
Initial treatment for the pain may involve one or a combination of the following interventions:
Once the initial period of severe pain is under control, a variety of treatments may be employed to address the underlying cause of the pain, such as a disc herniation, lumbar spinal stenosis, or degenerative disc disease
:
Modifying personal habits and lifestyle to prevent future exacerbation of the underlying cause of the pain is also important. For example, maintaining an appropriate body weight that's known not to aggravate the discs (this varies from patient to patient) as well as changing the way one goes about bending over for objects on the ground (heavy or light, it doesn't matter...all one has to do is bend in the wrong direction to invoke an episode). Another important lifestyle change that is usually recommended is to maintain a regular stretching and exercise program.
There are also a variety of surgeries that can be employed to treat severe cases of radicular pain, depending on the underlying condition that the surgery addresses. To treat a disc herniation, which may cause persistent radiating pain, a microdiscectomy surgery is usually performed. This is a minimally invasive approach that removes the portion of the disc that presses against the nerve root. The surgery has a high success rate, minimal healing time (typically the patient will go home on the same day as the surgery), and usually provides immediate relief of the sciatica and other symptoms caused by a herniated disc. This surgery may be recommended after several weeks of non-surgical treatment, or even earlier if the pain and other sciatica symptoms are severe. However, even in discal herniations, the long term outcomes do not differ between those who undergo surgery and those who do not. The decision to undergo surgery is not trivial, and is preferably made in consultation with two or more physicians.
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
"radiated" along the dermatome
Dermatomic area
A dermatome is an area of skin that is mainly supplied by a single spinal nerve.There are eight cervical nerves ,twelve thoracic nerves,five lumbar nerves and five sacral nerves....
(sensory distribution) of a nerve
Nerve
A peripheral nerve, or simply nerve, is an enclosed, cable-like bundle of peripheral axons . A nerve provides a common pathway for the electrochemical nerve impulses that are transmitted along each of the axons. Nerves are found only in the peripheral nervous system...
due to inflammation or other irritation of the nerve root
Nerve root
A nerve root is the initial segment of a nerve leaving the central nervous system. Types include:* A cranial nerve root, the beginning of one of the twelve pairs leaving the central nervous system from the brain stem or the highest levels of the spinal cord;...
(radiculopathy
Radiculopathy
Radiculopathy is not a specific condition, but rather a description of a problem in which one or more nerves are affected and do not work properly . The emphasis is on the nerve root...
) at its connection to the spinal column. A common form of radiculitis is sciatica
Sciatica
Sciatica is a set of symptoms including pain that may be caused by general compression or irritation of one of five spinal nerve roots that give rise to each sciatic nerve, or by compression or irritation of the left or right or both sciatic nerves. The pain is felt in the lower back, buttock, or...
– radicular pain that radiates along the sciatic nerve
Sciatic nerve
The sciatic nerve is a large nerve fiber in humans and other animals. It begins in the lower back and runs through the buttock and down the lower limb...
from the lower spine to the lower back, gluteal muscles, back of the upper thigh, calf, and foot as often secondary to nerve root irritation from a spinal disc herniation
Spinal disc herniation
A spinal disc herniation , informally and misleadingly called a "slipped disc", is a medical condition affecting the spine due to trauma, lifting injuries, or idiopathic, in which a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion A spinal disc herniation...
or from osteophytes in the lumbar
Lumbar
In tetrapod anatomy, lumbar is an adjective that means of or pertaining to the abdominal segment of the torso, between the diaphragm and the sacrum ...
region of the spine.
Treatment options
Seeking treatment for radiculitis should not be delayed. Depending on the severity, certain muscles (i.e.: in the toes, feet and calf) may start to atrophy over time, which in turn requires physical therapy for recovery. Also, radiculitis is known to cause patients to "favor" certain muscles (or a certain side of their body) which can result in the over-development of those muscles relative to the ones that don't get used as much.Initial treatment for the pain may involve one or a combination of the following interventions:
- One or two days of rest, if the pain is severe
- Application of ice (to reduce the inflammation) and/or heat (to encourage blood flow to help the irritated area to heal)
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofenIbuprofenIbuprofen is a nonsteroidal anti-inflammatory drug used for relief of symptoms of arthritis, fever, as an analgesic , especially where there is an inflammatory component, and dysmenorrhea....
or Relafen - Acetaminophen (paracetamol), e.g. Tylenol, which helps reduce the pain signals in the brain
- Spinal manipulationSpinal manipulationSpinal manipulation is a therapeutic intervention performed on spinal articulations which are synovial joints . These articulations in the spine that are amenable to spinal manipulative therapy include the z-joints, the atlanto-occipital, atlanto-axial, lumbosacral, sacroiliac, costotransverse...
or mobilization when lumbar spine related - GabapentinGabapentinGabapentin is a pharmaceutical drug, specifically a GABA analogue. It was originally developed for the treatment of epilepsy, and currently is also used to relieve neuropathic pain...
or the newer prescription medicine pregabalinPregabalinPregabalin is an anticonvulsant drug used for neuropathic pain and as an adjunct therapy for partial seizures with or without secondary generalization in adults. It has also been found effective for generalized anxiety disorder and is approved for this use in the European Union. It was designed... - Analgesics or pain killers, such as VicodinVicodinHydrocodone/paracetamol is a combination of two analgesic products hydrocodone and paracetamol used to relieve moderate to severe pain...
, PercocetPercocetThe combination oxycodone/paracetamol is a narcotic pain reliever used to treat moderate to severe acute pain, marketed by Endo Pharmaceuticals.-History:The U.S...
, or, in severe cases, a low dosage of MethadoneMethadoneMethadone is a synthetic opioid, used medically as an analgesic and a maintenance anti-addictive for use in patients with opioid dependency. It was developed in Germany in 1937... - Muscle relaxers, such as cyclobenzaprineCyclobenzaprineCyclobenzaprine is a muscle relaxant medication used to relieve skeletal muscle spasms and associated pain in acute musculoskeletal conditions. It is the most well-studied drug for this application, and it also has been used off-label for fibromyalgia treatment.- Mechanism of action :The mechanism...
or methocarbamolMethocarbamolMethocarbamol is a central muscle relaxant used to treat skeletal muscle spasms... - EpiduralEpiduralThe term epidural is often short for epidural analgesia, a form of regional analgesia involving injection of drugs through a catheter placed into the epidural space...
steroidal injections, which involves injecting a steroid (and sometimes a pain killer) directly into the problem area in the low back to treat the inflammation that is irritating the nerve root
Once the initial period of severe pain is under control, a variety of treatments may be employed to address the underlying cause of the pain, such as a disc herniation, lumbar spinal stenosis, or degenerative disc disease
Degenerative disc disease
Degeneration of the intervertebral disc, often called "degenerative disc disease" of the spine, is a condition that can be painful and can greatly affect the quality of one's life...
:
- ChiropracticChiropracticChiropractic is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. It is generally categorized as complementary and alternative medicine...
and/or Physical therapyPhysical therapyPhysical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
: stretching, manipulation and physical exercisePhysical exercisePhysical exercise is any bodily activity that enhances or maintains physical fitness and overall health and wellness. It is performed for various reasons including strengthening muscles and the cardiovascular system, honing athletic skills, weight loss or maintenance, as well as for the purpose of...
; often recommended after a period of one to two days of rest and treatment to get the pain under control. - Massage Therapy can be a useful adjunct in relieving pain; myofascial releaseMyofascial ReleaseThe myofascial release approach is a form of soft tissue therapy used to treat somatic dysfunction and resulting pain and restriction of motion. It is a treatment described by Andrew Taylor Still, founder of osteopathy/osteopathic medicine, and his early students, which uses continual palpatory...
may be helpful. - Yoga Therapy by a skilled Yoga Therapist is another excellent adjunct treatment .
Modifying personal habits and lifestyle to prevent future exacerbation of the underlying cause of the pain is also important. For example, maintaining an appropriate body weight that's known not to aggravate the discs (this varies from patient to patient) as well as changing the way one goes about bending over for objects on the ground (heavy or light, it doesn't matter...all one has to do is bend in the wrong direction to invoke an episode). Another important lifestyle change that is usually recommended is to maintain a regular stretching and exercise program.
There are also a variety of surgeries that can be employed to treat severe cases of radicular pain, depending on the underlying condition that the surgery addresses. To treat a disc herniation, which may cause persistent radiating pain, a microdiscectomy surgery is usually performed. This is a minimally invasive approach that removes the portion of the disc that presses against the nerve root. The surgery has a high success rate, minimal healing time (typically the patient will go home on the same day as the surgery), and usually provides immediate relief of the sciatica and other symptoms caused by a herniated disc. This surgery may be recommended after several weeks of non-surgical treatment, or even earlier if the pain and other sciatica symptoms are severe. However, even in discal herniations, the long term outcomes do not differ between those who undergo surgery and those who do not. The decision to undergo surgery is not trivial, and is preferably made in consultation with two or more physicians.