Lumbar Radicular Pain
Lumbar Radicular pain is caused by neuronal discharges emanating from inflamed nerve roots. The symptoms are back and/or buttock pain, which radiates into the leg in a dermatomal or nerve root-specific distribution. Pain along the inflamed nerve root can also be associated with neurological impairment. Besides pain, other symptoms may include numbness, tingling, and/or weakness in the lower extremities. The most common cause is lumbar disc herniation, however, a combination of degenerative changes producing nerve root compression can also cause pain in a similar fashion.
A non-herniated disc can also be the cause of radicular pain, this could be because of a tear in the annulus fibrosus slowly leaking contents from the nucleus causing an inflammatory cascade along the nerve roots. This is a likely cause of pain in cases than there is radicular pain or pain radiating into the extremities without evidence of nerve compression on an MRI study.
Diagnosis:
If patient’s history and physical examination indicate radicular pain, then the best diagnostic study is a lumbar spine MRI. For those patients who are unable to have a lumbar spine MRI, the next most appropriate test is a CT or a CT myelogram. Electrodiagnostic studies like an EMG or a nerve conduction study can also be used to distinguish between the various causes of nerve root compression or inflammation of nerve roots. These tests can also be used to look for other causes of nerve damage when other studies like MRI or a CT scan are inconclusive.
Treatment:
Conservative treatment is the first recommended treatment option for most cases of radicular pain emanating from the lumbar spine.
1 Rest
2 Activity modification
-the goal is to avoid the aggravation of the injured lumbar disc.
– avoid lifting heavy objects.
– avoid activities e.g. sporting activities, walking, running.
3 Exercise and physical therapy.
4 Application of heat and or ice.
5 Medications (NSAIDS, Tylenol, muscle relaxants, medications for nerve pain e.g. gabapentin or Lyrica, opioids can be considered on a case-by-case basis if other conservative measures and non-opiate medications have failed.)
6 Lumbar epidural steroid injection.
7 Endoscopic discectomy DISC FX
8 Decompressive lumbar spine bracing
If you suffer from Lumbar Radicular Pain give Dr. Rajan Kalia a call today at 407-284-1993.
Risk Factors
Lumbar Radicular pain is a little bit more common in male populations, and the peak age at time of disk surgery is 40 years old. Other risk factors may include driving occupations, frequent lifting of heavy objects, heavy industry work, back trauma, taller height, smoking, being overweight, leading a sedentary lifestyle, multiple pregnancies, a history of back pain, and having a chronic cough. Environmental factors account for the majority of sciatica cases, even though having a family history of herniated disks is also a risk factor.
Rehabilitation & Pain Management
70%-80% of patients experience improvement in pain and disability within four to six weeks while treated with relative rest and activity modification, which means that only 1-10% of patients will require surgery. Rehabilitation management is based on a return to activity.
