Radicular Pain

Radicular pain is a condition where pain radiates along a nerve pathway from the spine to other parts of the body, caused by compression or irritation of nerve roots where they exit the spinal column.

Table of contents

• What Is Radicular Pain?
• Other Names for This Condition
• Parts of the Body Affected
• Types of Radicular Pain
• Signs and Symptoms
• What Causes Radicular Pain
• Who Is Affected
• How It Is Diagnosed
• Treatment Options
• Outlook and Recovery

radiculitis, radiculopathy

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M54.1

What Is Radicular Pain?

Radicular pain is pain that “radiates” or travels along the path of a nerve from the spine to other areas of your body. This happens when a nerve root (the part where a nerve branches off from the spinal cord) becomes compressed, irritated, or inflamed at its connection to the spinal column^[1].

The term comes from the Latin word “radicula,” which means “small root,” referring to these nerve roots^[4]. Because nerves from the spinal cord travel to different parts of the body, you can feel pain in areas far from where the actual nerve compression is occurring in your spine^[3].

Radicular pain is relatively common, affecting about 3 to 5 percent of people at some point in their lifetime^[3]. One study found the annual incidence to be 83 per 100,000 people^[8].

Other Names for This Condition

Radicular pain is also commonly referred to as radiculitis or radiculopathy^[1]. While these terms are related, there are slight differences. Radiculitis specifically indicates inflammation of the nerve root, which may lead to pain without weakness. Radiculopathy is the broader term that includes both pain and other symptoms like numbness or weakness when the nerve root is affected^[4].

When radicular pain affects the sciatic nerve (the longest nerve in the body, running from the lower back down each leg), it is commonly called sciatica^[1].

Parts of the Body Affected

• Spine
• Spinal cord
• Nerve roots
• Intervertebral discs
• Vertebrae
• Spinal canal

The spine is made up of 33 bones called vertebrae that are stacked on top of each other. Between each vertebra is a cushion-like structure called an intervertebral disc. These discs act as shock absorbers between the bones^[17].

On the sides of each vertebra are openings in the bone where nerve roots exit the spinal canal and travel to other parts of your body, including your hips, legs, arms, and feet^[17]. When something compresses or irritates these nerve roots near where they exit the spine, radicular pain can develop.

Types of Radicular Pain

Radicular pain is classified into three main types based on where along the spine the nerve compression occurs^[1]:

Cervical Radiculopathy

This type affects the neck region, involving the first seven vertebrae starting from the bottom of the skull. When nerves in this area are compressed, you may feel pain, numbness, or tingling in your neck, shoulders, arms, hands, or fingers^[5].

Thoracic Radiculopathy

This is the rarest form of radicular pain, affecting the upper and middle back region. It can cause pain or numbness in the chest, ribs, sides, or abdomen. Sometimes this pain can be mistaken for other conditions^[5].

Lumbar Radiculopathy

This is the most common type, affecting the lower back. The lumbar spine is responsible for sensation and movement in the legs^[18]. Pain from lumbar radiculopathy can be felt in the buttocks, legs, or feet, and may include the well-known condition called sciatica^[5].

Signs and Symptoms

The symptoms of radicular pain can vary from person to person and depend on which nerve root is affected and how severely it is compressed. The pain experienced can range from a dull ache that’s difficult to pinpoint to a sharp, burning sensation^[3].

Common symptoms include^[1]:

• Pain in the area around the affected nerve that may be throbbing, aching, shooting, sharp, dull, or burning
• Tingling sensations along the nerve pathway
• Numbness in affected areas
• Muscle weakness in the affected region

The most common symptom is paresthesia, which is an abnormal sensation like tingling or “pins and needles”^[2]. Another common presentation is back pain that radiates into the foot^[2].

Additional symptoms may include^[17]:

• Inability to bend or rotate the back
• Increased pain when coughing, sneezing, or sitting
• Difficulty getting up from a chair
• Pain that is worse in the morning
• Difficulty standing up straight or feeling “stuck” in certain positions
• Limping when walking

Importantly, muscle strength is often preserved in cases of radicular pain because muscles typically receive signals from multiple nerve roots. Therefore, muscle weakness usually only occurs in severe cases where nerve compression is significant^[2].

Depending on how severe your symptoms are, it might be hard or uncomfortable to sit, stand, or move. The pain can be constant or come and go, and its intensity can vary^[1].

What Causes Radicular Pain

Radicular pain occurs when a nerve root becomes compressed or irritated. The most common causes are either a herniated disc (when the soft center of a spinal disc pushes through a crack in the outer casing) or spondylosis (age-related wear and tear on the spine)^[2].

A herniated disc can result from either an acute injury or chronic degeneration of the spine. When the disc material protrudes, it can press against nearby nerve roots, causing pain and discomfort^[18]. The herniation also activates pain receptors in surrounding tissues such as ligaments, blood vessels, and the dura mater (the outer membrane covering the spinal cord)^[2].

Other causes of nerve root compression include^[17]:

• Bone spurs: Extra bone growth that can narrow the space where nerves exit
• Spinal stenosis: A narrowing of the spaces within the spine, which can put pressure on nerves
• Arthritis or degenerative joint disease in the spine
• Trauma from accidents, such as whiplash from car collisions or sports injuries
• Spondylolisthesis: A condition where one vertebra slips out of place

Radicular pain can develop suddenly from an acute injury or gradually over time from chronic conditions. Poor posture maintained over weeks, months, or years can slowly overstretch ligaments in the back, allowing pressure to build on spinal nerves. As the pressure increases, pain can travel farther along the nerve pathway^[1].

Risk factors that increase the likelihood of developing radicular pain include repeated lifting, participating in weight-bearing sports, obesity, smoking, sedentary lifestyles, and poor posture^[17].

Who Is Affected

Radicular pain can affect anyone, but it is more common in people older than 50 years of age^[1]. Studies show that it most often affects people between the ages of 30 and 50^[17]. Men are affected slightly more than women^[8].

In one survey, about 15 percent of people with radiculopathy reported that it began after physical exertion or trauma^[8].

While neck pain and back pain are common problems, they are rarely caused by radiculopathy. The condition itself is considered relatively rare compared to other causes of back or neck discomfort^[1].

How It Is Diagnosed

The first step in diagnosing radicular pain is obtaining an accurate assessment. A healthcare provider will typically perform a physical examination and review your symptoms and medical history^[15].

It can be challenging to determine what’s causing your pain, which is why it’s important to see your healthcare provider as soon as you notice any new symptoms, especially if they last more than a few days^[1].

Your doctor may order imaging tests to identify the exact location and cause of nerve compression. Common imaging tests include^[15]:

• X-rays
• MRI (Magnetic Resonance Imaging)
• CT scans (Computed Tomography)
• CT myelography

However, imaging is not always a helpful diagnostic tool on its own. Studies have found that almost 27 percent of patients without back pain have disc herniation visible on MRI. Furthermore, this finding does not predict future back pain development^[2].

To properly diagnose a herniated disc as the source of your pain, it’s important to review your complete history and physical examination, and ensure that the symptoms match the imaging results^[2].

Your doctor may also perform specific tests during the physical examination, such as a straight leg raising test, which is commonly positive in patients with back pain radiating into the foot^[2].

Treatment Options

Most cases of radicular pain improve over time with focused, non-surgical treatment. The majority of patients respond well to conservative management^[2][17].

Conservative Treatments

Initial treatment often involves simple approaches aimed at relieving pain and reducing inflammation. These may include^[1]:

• Improving your posture
• Rest and avoiding activities that worsen the pain
• Over-the-counter pain relievers such as ibuprofen or acetaminophen for mild to moderate pain
• At-home physical therapy exercises

In some cases, radicular pain improves with no treatment at all^[1].

Medications

If over-the-counter medications aren’t sufficient, your doctor may prescribe stronger medications. Options include^[15]:

• Prescription pain relievers or muscle relaxants for severe pain
• NSAIDs (nonsteroidal anti-inflammatory drugs) to help reduce inflammation around nerve roots
• Medications specifically for nerve pain, such as anticonvulsants (like gabapentin or pregabalin) or certain antidepressants
• Opioids for short-term relief (up to eight weeks) in cases of acute neuropathic pain

Physical Therapy and Exercise

Physical therapy plays a central role in treating radicular pain. A physical therapist can design a personalized exercise program focusing on^[15]:

• Strengthening muscles that support the spine
• Improving flexibility
• Reducing pressure on affected nerves
• Stretching tight muscles

Specific exercises can help alleviate pain, improve posture, and prevent further injury. Physical therapy may also include hands-on techniques such as spinal mobilization to improve spinal alignment and reduce nerve compression^[15].

After acute pain subsides, exercises and manipulation should focus on stretching and strengthening^[8].

Immobilization and Traction

A short period (about one week) of immobilization using a cervical collar, splint, or brace may help relieve radicular pain^[8][9]. Home cervical traction units may provide temporary relief by decompressing nerve impingement^[8].

Injections

Corticosteroid injections may be administered directly into the space around the affected nerve. These injections can provide significant relief by reducing inflammation and swelling. Common injection procedures include^[15][9]:

• Epidural steroid injections
• Selective nerve root blocks

Selective nerve root blocks may relieve radicular pain, though rare serious complications can occur^[8]. These injections are often used in combination with other treatments to manage severe pain.

Lifestyle Changes

Making lifestyle modifications can help manage and prevent radicular pain^[15]:

• Maintaining a healthy weight to reduce stress on the spine
• Regular low-impact exercises such as walking, swimming, or cycling
• Practicing proper posture, especially during sitting or lifting
• Avoiding prolonged sitting or standing
• Taking frequent breaks to move around
• Using supportive footwear
• Ensuring your workstation is ergonomically designed

Topical Treatments

Some patients have found relief using topical formulations applied directly to the affected area. Case reports suggest that multi-ingredient topical agents may help reduce pain and improve function when used alongside other treatments^[10].

Surgical Options

Surgery is generally considered a last resort and is reserved for cases where conservative treatments fail to provide relief after about 12 weeks, or when there is significant nerve compression leading to severe pain or neurological symptoms like progressive weakness or loss of function^[2][9].

Surgical procedures may include^[9]:

• Discectomy: Removal of part of a herniated disc to relieve pressure on the nerve
• Laminectomy: Removal of part of the vertebral bone to create more space for spinal nerves
• Spinal fusion: Stabilizing the spine by fusing two or more vertebrae together

On rare occasions, nerve compression can cause loss of bladder or bowel control, in which case immediate surgery is recommended^[17].

Outlook and Recovery

The overall outlook for people with radicular pain is favorable. Most cases are self-limited, meaning they improve on their own over time^[2]. Radicular pain is typically a temporary issue that heals over time and often goes away without treatment^[1].

Patients with radicular pain often respond well to conservative management, and most improve with a focused, non-surgical treatment approach^[2][17].

However, early treatment is important to prevent the condition from worsening. A slight ache or dull pain can become more severe over time if the same activities or conditions continue to irritate the nerve. Early intervention can help prevent further health complications and longer recovery times in the future^[3].

If conservative treatments don’t provide adequate relief, patients who do not respond may need additional evaluation with MRI and possible referral to a specialist for interventional therapies or surgical options, depending on the severity of symptoms^[2].

Regular participation in physical therapy and maintaining healthy lifestyle habits are essential for long-term pain management and recovery^[15].