Radiculalgia, also called radicular pain, is most often due to compression of the root of a spinal nerve (attached to the spinal cord) near the spine. The causes of this compression can be osteoarthritis of the spine, a herniated disc, or a bone or nerve tumor. Immunological causes have also been described. A person with radiculalgia frequently suffers from acute pain. The treatment is on the one hand medicinal, and is based, on the other hand, mainly on rehabilitation by a physiotherapist. Alternative techniques exist, and relaxation or meditation can help relieve pain-related anxiety.
What is radiculalgia?
Radiculalgia is a pain of nervous origin. This pain is called radicular since it affects the root of the nerves. This condition is frequently caused by the compression of a spinal nerve (attached to the spine) at its root. Such compression can be due to osteoarthritis of the spine, a herniated disc, or a bone or nerve tumor. Etymologically, the term radiculalagia is formed from the Latin 'radicula', diminutive of radix which means root, and the suffix of Greek origin 'algie' which means pain. This pain is often very intense. It manifests itself all along the path of the nerve. Starting from the spine, it extends to the upper or lower limbs and is often accompanied by sensitivity disorders.
Multifactorial pain
Radiculalgia is, in fact, multifactorial: it combines both mechanical and chemical factors. The most common mechanical factors are exertion, such as lifting a heavy load, false movement such as twisting the body. As for the most frequent chemical factors, they involve the simple contact of the nerve with tissue located between the discs, which is capable of causing an inflammatory reaction. This will induce a reduction in the speed of nerve conduction.
Diagnosis of radiculalgia
The diagnosis of radiculalgia is based on neuroimaging (computed tomography or magnetic resonance imaging) of the affected area. Sometimes it is necessary to also carry out electrophysiological examinations. If the imaging has not detected any anatomical abnormality, the analysis of the cerebrospinal fluid will make it possible to look for infectious or inflammatory causes. In addition, fasting blood glucose will also be studied for possible diabetes.
What causes radiculalgia?
Root disorders are caused by chronic or acute hyperpressure that affects a nerve root, inside or near the spine. The pain comes, most often, from the compression of this nerve root at the level of a vertebra, and it can be caused by:
- A hernia of the intervertebral disc. This is the appearance of a herniated disc at the level of the disc located between two vertebrae;
- Bone deformities caused by rheumatoid arthritis or osteoarthritis, which can compress nerve roots in isolation. Thus, the wear of the intervertebral disc caused by osteoarthritis, for example, can result in radiculalgia;
- Narrowing of the spinal canal in the middle of the vertebrae of the lower back, which causes pinching of the nerve roots;
- The development of a bone or nerve tumor;
- In addition, the appearance of postoperative radiculalgia can also occur after disc surgery.
The first cause of radiculalgia: herniated disc
Herniated disc is the leading cause of radicular pain. The classic explanation is that of mechanical compression or deformation of the nerve roots, which is the primary cause of pain. However, you should also know that in addition, radiculalgia could be caused by an inflammatory or immune component that can occur with the herniated disc. The results of a scientific study showed that changes in the subsets of peripheral blood T cells occur as a result of prolapse of the lumbar invertebrate discs. The authors of the study concluded that immunological mechanisms would likely be at play in herniated disc pain. In addition, an increase in certain cytokines could also contribute to root pain.
What are the symptoms of radiculalgia?
The most common symptoms of radiculalgia are:- very frequently acute pain;
- tingling, numbness, tingling;
- weakness of the limbs or even paralysis;
- anesthesia of the skin;
- In addition, coughing, sneezing, or pushing can increase the pain.
How to treat radiculalgia?
Treating chronic pain is complex, with paracetamol and steroidal anti-inflammatory drugs often only partially effective and prolonged use of NSAIDs posing a significant risk.
The treatment of radiculalgia aims both to relieve pain and to limit the disability it induces. The treatment is based above all on drug treatment, as well as rehabilitation by a physiotherapist who will relieve tension in the vertebral.
Drug treatments
- Analgesics (painkillers): often, paracetamol, an analgesic of palliation I, is insufficient. It can therefore be combined with caffeine, codeine, or tramadol. As for morphine (palliate III analgesics), they must be used sparingly, and reserved for hyperalgesic radiculalgia;
- Nonsteroidal anti-inflammatory drugs (NSAIDs): ketoprofen, diclofenac, naproxen are often prescribed in combination with palliate II analgesics. Their pain-relieving effect is not superior to painkillers alone. They should not be used for a period of more than ten days to two weeks. If the pain recurs after a stop of a few days, they can be prescribed for a longer period of time;
- Antiepileptics: pregabalin, gabapentin, and pregabapentine are molecules used because they act on the nerve fiber itself;
- Corticosteroid therapy: Prednisone and prednisolone are second-line corticosteroids if nonsteroidal anti-inflammatory drugs have not been shown to be effective in fighting pain. They are issued over a short period of time, from seven to ten days. They can also be administered by infiltration, which makes it possible to deliver a high concentration of active product at the level of pain. They are mainly indicated only in the absence of improvement after three weeks of drug treatment.
Non-drug treatments
- Lombostat: it is a rigid shell made to measure by an orthoprosthetist. Made of plastic, leather, steel, or even plaster or resin, the lombostat allows a relative immobilization of the lumbar vertebrae, by means of support that extends from the side of the pelvis to the last ribs. Its action consists in achieving a lumbar blockage by solidarization of the trunk to the pelvis. Concretely, it, therefore, avoids false movements as well as ensuring a rest of the back. In addition, it reduces the stress on the vertebrae;
- Rehabilitation: rehabilitation sessions by the physiotherapist relieve tension in the vertebrae, and allow retraining of the effort in order to put his back on his back. Even in case of pain, it is very important to stay mobile and active. The purpose of this training is to strengthen your muscles, improve your physical abilities, and the exercises practiced range from cycling to running through the sheathing, abdominal exercises, etc.;
- Yoga and swimming: the practice of these two sports will relax the spine, but also relieve muscle contractures;
- Osteopathy: it reduces compression. Thus, this method of unconventional medicine aims to relieve a functional disorder. It is based on manual manipulations of the musculoskeletal system as well as myofascial relaxation techniques;
- Surgery: it can be used last
Preventing radiculalgia / alternative therapies
Prevention of radiculalgia
- avoid twisting movements of the trunk when you want to catch something that is behind you;
- prefer backpacks to handbags and use both shoulders to carry the backpack;
- Or adopt a good position while sleeping, especially by having a comfortable mattress and a pillow that does not create too large an angle at the neck.
Alternative therapies
- Transcutaneous electrical neurostimulation;
- Thermotherapy;
- Acupuncture;
- Relaxation and meditation: these two methods help to de-dramatize the fears that lead to the fear of movement, but also to relieve anxiety and stress related to pain.
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