Dr. Kaliq Chang explains radicular pain and some tips for coping with this common spine problem.
Radiculitis can affect any part of the spine but is most common in the lower back or neck. The resulting back pain can be chronic or can come and go, and sometimes it's severe.
What is radicular pain?
Radicu-what? Perhaps the only thing more ridiculous than the name radiculitis is how much pain this spine problem can cause. But the good news about radiculitis "which is extremely common" is that most patients recover quickly, says Dr. Chang.
Exactly what is radiculitis? It's the term describing pain that radiates along a nerve path connected to the spinal column, Dr. Chang says. Radiculitis can affect any part of the spine, but is most common in the lower back or neck. The resulting lower back pain can be chronic or can come and go, and sometimes it's severe.
"Radiculitis isn't technically a condition in itself," explains Dr. Chang, who is fellowship-trained in interventional pain management. "It's the symptoms felt when a nerve or nerve root coming from the spine is pinched, irritated, inflamed, or simply put, just not working properly."
Radicular Pain Types
Radicular pain, also known as radiculopathy, is a condition that occurs when a nerve root in the spine becomes compressed or irritated. This compression can result from various causes, such as a herniated disc, spinal stenosis, degenerative disc disease, or spondylolisthesis. Radicular pain typically radiates along the path of the affected nerve root, leading to discomfort, numbness, tingling, or weakness in specific areas of the body. There are several types of radicular pain based on the location and affected nerve roots.
Cervical Radicular Pain originates from the nerve roots in the cervical (neck) region of the spine. It commonly leads to pain, tingling, and weakness that radiates down the arms and into the hands. Cervical radicular pain may be caused by conditions like cervical disc herniation or cervical spinal stenosis.
Thoracic radicular pain occurs when the nerve roots in the thoracic (mid-back) region of the spine are compressed or irritated. This type of radicular pain is less common compared to cervical or lumbar radicular pain. It can cause pain, numbness, or tingling that extends around the chest and abdomen.
Lumbar radicular pain is the most prevalent type and affects the nerve roots in the lumbar (lower back) region of the spine. It is often caused by conditions such as lumbar disc herniation, degenerative disc disease, or spinal stenosis. The pain usually travels from the lower back into the buttocks, thighs, and sometimes down to the feet. It may be accompanied by muscle weakness or loss of sensation in the affected areas.
Sacral radicular pain originates from the nerve roots in the sacral region, which is located at the base of the spine. It can cause pain that radiates down the back of the leg, similar to sciatica. Sacral radicular pain may be associated with conditions like sacroiliac joint dysfunction or sacral spinal stenosis.
The treatment for radicular pain depends on its underlying cause and severity. Non-surgical interventions, such as physical therapy, pain medications, epidural steroid injections, and rest, are often tried initially. If conservative measures fail to provide relief, surgical options like discectomy, laminectomy, or spinal fusion may be considered.
It's crucial to consult with a medical professional for an accurate diagnosis and appropriate management of radicular pain. They can evaluate your symptoms, conduct necessary tests, and recommend an individualized treatment plan to alleviate your discomfort and improve your quality of life.
Radicular Pain Causes
Radicular pain, also known as radiculopathy, occurs when a nerve root in the spine becomes compressed or irritated. Several underlying conditions can lead to the development of radicular pain. Here are some common causes:
- Herniated Disc;
- Spinal Stenosis;
- Degenerative Disc Disease;
- Spondylolisthesis;
- Tumors or Growths;
- Traumatic Injury;
- Infections or Inflammation.
Radicular Pain Symptoms
Radicular pain is characterized by symptoms that result from the compression or irritation of a nerve root in the spine. These symptoms typically follow a specific pattern based on the location of the affected nerve root.
Radicular pain is often described as a sharp, shooting, or electric-like pain that radiates along the path of the affected nerve root. The pain may start in the spine and then travel down the arm or leg, following a specific dermatomal pattern. For example, in cervical radiculopathy, the pain may radiate down the arm, while in lumbar radiculopathy, it may extend into the buttocks, thigh, or leg.
Many individuals with radicular pain experience numbness or tingling sensations in the areas supplied by the affected nerve root. This can manifest as a "pins and needles" sensation or a feeling of reduced sensitivity in specific regions. The numbness and tingling often follow the same dermatomal distribution as the pain.
Radicular pain can lead to muscle weakness in the areas innervated by the affected nerve root. This weakness may manifest as difficulty in gripping objects, reduced strength while walking or lifting, or a general feeling of weakness in the affected limb.
Radiculopathy can cause sensory changes, such as altered perception of temperature, touch, or pressure. Some individuals may experience heightened sensitivity to certain stimuli, while others may have decreased sensation in specific areas.
Compression of a nerve root can affect the reflexes associated with that particular nerve. For example, in lumbar radiculopathy, the knee or ankle reflex may be diminished or absent on the affected side. Radicular pain can also lead to abnormal reflexes. For instance, when the nerve root is compressed, tapping certain areas may elicit unexpected or exaggerated reflex responses.
The pain and other symptoms associated with radicular pain often radiate beyond the spine and into the extremities. The specific regions affected depend on the location of the compressed or irritated nerve root.
Radicular Pain Risk Factors
Nerve roots at the spine can be injured in many ways falls, auto accidents, sports injuries and even aging itself are all culprits. These back injuries can damage discs between spinal vertebrae, which then emit a chemical through a crack in their outer shell that touches a nerve. It can also happen when pressure is placed on a nerve from other conditions, such as arthritis; a bone spur; a herniated disc; or spinal stenosis (which narrows the canal surrounding nerves), among other causes.
But while radiculitis can't always be prevented, certain risk factors predispose some people to it. These include:
- Participating in heavy labor or contact sports
- A family history of radiculitis or other spine disorders
- Diabetes, which can decrease normal blood flow to spinal nerves
Maintaining a reasonable weight, diligent muscle conditioning, and avoiding excessive strain on the back and neck can also help lower the odds of developing radiculitis.
"The most common symptoms of radiculitis are pain, numbness or tingling in the arms or legs," Dr. Chang says. "Some patients may have localized neck or back pain as well. When radiculitis occurs with pain radiating down the leg, it's also often called sciatica" a term with which many more people are familiar."
Radicular Pain Treatment
Unless there are concerns about nerve death or other permanent injury, patients with radiculitis should always opt for conservative, nonsurgical treatment first, including epidural steroid injections Dr. Chang says. But treatment choices should follow a diagnostic process that may include a physical exam along with imaging scans that confirm herniated discs or other spinal conditions leading to radiculitis.
According to Dr. Chang, conservative treatments for radiculitis include:
- Rest. "Patients who can manage to completely stay off their feet for the first 24 to 48 hours after an injury may dramatically help the situation," he says.
- Pain relievers, including NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen, which relieves swelling and pressure.
- Physical therapy.
- Epidural steroid injections into the spinal area.
Surgery to treat radiculitis is only considered if all these options fail to reduce debilitating pain that prevents patients from going about their daily activities, he says. Surgical procedures can often be done endoscopically, using tiny incisions leading to less blood loss and pain and a quicker recovery.
Home Remedies
While it's important to consult with a healthcare professional for an accurate diagnosis and appropriate treatment of radicular pain, there are some home remedies that may help alleviate symptoms and promote overall well-being. However, it's crucial to note that these remedies should complement medical guidance and not replace it.
Resting and avoiding activities that exacerbate pain can help reduce symptoms. Maintaining good posture, especially while sitting and standing, can also alleviate pressure on the spine and nerve roots. Applying heat or cold to the affected area can help reduce pain and inflammation. You can use a heating pad, warm towel, or hot water bottle for heat therapy, or an ice pack wrapped in a cloth for cold therapy. Alternate between the two for optimal results.
Engaging in gentle stretching exercises can help improve flexibility and relieve muscle tension. Low-impact exercises like walking, swimming, or cycling may also be beneficial. However, it's essential to avoid activities that worsen pain and consult with a healthcare professional before starting any exercise program.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may help reduce pain and inflammation associated with radicular pain. Follow the recommended dosage and guidelines provided by the pharmacist or consult a healthcare professional.
Some herbal remedies may have anti-inflammatory or pain-relieving properties. Examples include turmeric, ginger, boswellia, and devil's claw. However, it's essential to exercise caution when using herbal remedies and consult with a healthcare professional or herbalist for appropriate dosages and potential interactions with medications.
Stress can exacerbate pain and discomfort. Engaging in stress reduction techniques, such as deep breathing exercises, meditation, yoga, or mindfulness, may help promote relaxation and alleviate symptoms. Making ergonomic adjustments to your workstation, such as using an ergonomic chair, maintaining proper posture, and positioning computer screens at eye level, can help reduce strain on the spine and alleviate symptoms.
It's important to remember that these home remedies may provide temporary relief, but they may not address the underlying cause of radicular pain. "There's no reason not to be optimistic if you're suffering from radiculitis, since the outlook is good," Dr. Chang says. "Most patients respond well to conservative treatment choices, and those who need surgery typically also have no lingering issues. The vast majority of radiculitis cases resolve within 6 weeks to 3 months."
