Pain Management in Radiculopathy: A Literature Review

Introduction: Radiculopathy is caused by compressed nerves in the spine at or near the level of
the nerve root. The location of radiculopathy depends on the affected nerve root. Common
symptoms of radiculopathy include radicular pain, numbness, tingling, and muscle weakness.
Cervical and lumbar radiculopathy can be triggered by factors such as herniated discs, pulsation,
trauma, osteoarthritis, inflammation, and rarely tumors or diabetes. Lumbar and cervical
radiculopathy can be diagnosed by physical examination, diagnostic imaging, and electrical
diagnosis. Most patients with radiculopathy have non-surgical and conservative management
such as drug therapy (corticosteroids, non-steroidal anti-inflammatory drugs, tricyclic
antidepressants, analgesics, muscle relaxants), physical therapy, chiropractic treatment, spinal
manipulation, traction, and corticosteroid injections. In this literature review, we will discuss
about the pain management in radiculopathy.

Method: We searched PubMed and Google Scholar from January 1 st, 2012 to January 1st, 2022
for pain management in radiculopathy. We restricted our analysis to the pain mangement in
radiculopathy. Review articles, letters, reports and duplicates were excluded. The remaining
studies were screened based on titles and abstracts and full articles were then reviewed.

Discusion: Oral corticosteroids prescribed as a taper may benefit patients in the acute phase. The
next step in treatment is often pain injections that may include epidural steroid injections, facet
injections, or transvertebral foramen injections, which have been shown to provide long-term
symptom relief. These injections usually consist of a combination of anti-inflammatory drugs
such as glucocorticoids and long-acting anesthetics such as marcaine. In situations where the
source of pain is uncertain, spinal injections can be both diagnostic and therapeutic. For example,
a patient with severe low back pain and numbness in the left leg with widespread arthritic
changes throughout the spine may be injected into the facet with significantly alleviated
symptoms. Injections into the lumbar facet joints resulted in a significant relief of the symptoms,
and changes in the facet joint arthritis rather than lumbar radiculopathy from compressed nerve
roots caused the pain. However, patients with significant leg pain with the L5 dermatome pattern
experience significant relief after epidural injection. This suggests that the source of pain is
likely to be the compressed left L5 radiculopathy rather than the changes in arthritis of the facet
joints.

Conclusion: Lumbar radiculopathy is one of the most common neurological conditions

evaluated by neurosurgeons practicing in a rural environment. The pathology has not changed,
but newer, less invasive techniques are being developed to surgically treat these patients in the
evolving areas of spinal surgery. Complete knowledge of signs, symptoms, warning signs,
radiographic images, diagnostic tools, and conservative and surgical procedures is required. Pain
management is important in treating patients with radiculopathy.