Radicular pain, or radiculitis, is pain "radiated" along the dermatome of a nerve due to inflammation
or other irritation of the nerve root 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.
Treatment options Seeking treatment for radiculitis should not
be delayed.
Depending on the severity, certain muscles 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 which can result
in the overdevelopment of those muscles relative to others, causing abnormal torque on joints
that can cause degenerative damage.
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 and/or heat
Non-steroidal anti-inflammatory drugs, such as ibuprofen or nabumetone
Acetaminophen, e.g. Tylenol, which helps reduce the pain signals in the brain
Spinal manipulation or mobilization when lumbar spine related
Gabapentin or the newer prescription medicine pregabalin
Analgesics or pain killers, such as Vicodin, Percocet, or, in severe cases, a low dosage
of Methadone Muscle relaxers, such as cyclobenzaprine or
methocarbamol Epidural steroidal injections, which involves
injecting a steroid directly into the problem area in the 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:
Physical therapy: stretching and physical exercise; 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 release may be
helpful.
Yoga therapy by a skilled yoga therapist is another excellent adjunct treatment.
Chiropractic Acupuncture
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
as well as changing the way one goes about bending over for objects on the ground.
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, 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.
See also Intervertebral disc
Sciatica Spinal disc herniation
References