Radiculopathy

Let’s talk about sciatica- one of the most common complaints I get in my clinic.  The medical term for sciatica is radiculopathy, so I’ll be using that term from here on in this post.  

Most of my readers probably can spot the symptoms of radiculopathy.  This type of pain is often described as burning, sharp, shooting and is associated with numbness and tingling in the same area as the pain.  Sometimes people who have radiculopathy can also experience weakness, meaning that when they try to move a certain muscle or group of muscles, the area feels less strong.  This is different from having trouble moving a part of the body due to pain, and it can be tricky to tease this out without a good physical examination.

Radiculopathy can occur in the legs, known as lumbar radiculopathy, and in the arms, known as cervical radiculopathy.  Lumbar radiculopathy can be associated with low back pain too, and cervical radiculopathy can also show up with neck pain.  

The causes of lumbar radiculopathy are most commonly related to either a disc that has herniated in the spine, or stenosis, which is a narrowing in the spine.  Foraminal stenosis is narrowing of the hole that the spinal nerve goes through on its path down to the arm or leg, and central stenosis is narrowing of the area in the center of the spinal canal where the spinal cord and nerves run.  A disc herniation is a way of describing an issue where the disc, the squishy Jello-like material between the spinal bones, has moved out of its normal position. No matter which cause, the end result is compression of a spinal nerve, which gives the symptoms I mentioned earlier.

To better determine what the exact issue is, the next step in diagnosis is generally an MRI of the neck or the low back.  Unfortunately, sometimes insurance companies will not approve this test unless the patient has tried and failed some type of therapy, which I discuss next.

The treatment options for radiculopathy are widely varied.  Generally the most effective type of medications are nerve pain medications, which target the true cause of the problem- irritation of the nerve.  These are generally anti-seizure medications or antidepressant medications that we know also work on nerves. Sometimes I will use anti-inflammatory medications or muscle relaxants if the patient has a lot of muscle spasm too, but these are less effective for the burning/tingling nerve pain.  

I almost always recommend a course of physical therapy to patients with radiculopathy.  Physical therapy is very helpful in not only relieving some of the pain, but also being proactive about preventing radiculopathy from turning into a chronic issue.  For lumbar radiculopathy, patients will be taught exercises to strengthen their core muscles (abs and muscles of the low back), and will work on posture and walking mechanics, among other therapies.  

Injections are another common therapy for radiculopathy.  Epidural steroid injections can be very helpful in reducing inflammation that may be present near the nerve as a result of the compression.  These are done with an X-ray machine in order to precisely target the area of the problem. If the pain is persistent and severe, sometimes I will consider a different type of therapy called a spinal cord stimulator, which is an implantable device that hides the pain of radiculopathy from the brain.

Complementary therapies are useful too- I have many patients who do well with acupuncture and mindfulness-based therapies for this type of pain.  It is very common to have patients who need more than 1 type of therapy in order to feel their best.

If the pain persists despite these therapies, or if the patient has weakness when I examine them, I will send the patient to a spine surgeon for evaluation.  Sometimes patients may need surgery to relieve the compression of the nerve.

If you’re wondering if you have radiculopathy, the best way to find out is to see a pain management doctor in person!  Don’t forget to subscribe to my blog here so that you never miss an update.