Assessing radicular pain in people with back and neck pain

Radicular pain (pain due to compromise of spinal nerve roots) is often described as a sharp, shooting or burning pain that radiates. It is sometimes associated with a ‘pins and needles’ sensation. Pain is often experienced in a dermatomal distribution; however, this is nonspecific because of the extensive overlap of dermatomes. Pain may be aggravated by coughing, sneezing or straining.

Radicular pain is not necessarily associated with a serious pathology. In the absence of severe or progressive neurological deficits, radicular limb pain alone may not represent a serious pathology. People with radicular pain who may require further investigation and treatment include those who develop motor symptoms and those with progressive or persistent radicular pain.

Neurological examination is fundamental to the assessment of people who report neurological symptoms (eg pain, weakness, altered sensation, bladder or bowel dysfunction). Neurological signs (eg sensory level, weakness, hypo- or hyperreflexia, sensory loss) may warrant further investigation to exclude or confirm a diagnosis.

Cervical radicular pain typically radiates from the neck down one arm, but pain may radiate down both arms. Pain is often accompanied by neurological symptoms or signs (eg paraesthesia, numbness, weakness).

Thoracic radicular pain is typically perceived in the back and radiates around the chest wall and abdomen along the segmental dermatome of the thoracic ventral spinal nerves. Thoracic radicular pain occurs less frequently than lumbar or cervical radicular pain. The presence of thoracic radicular pain should alert the clinician to the possibility of systemic pathologies such as diabetic radiculopathy or, if skin rash is present, herpes zoster (shingles). Thoracic disc herniation is an uncommon cause of isolated radicular pain but, if present, may compromise the spinal cord causing myelopathy.

Lumbar radicular pain (often referred to as ‘sciatica’) radiates down the lateral or posterior side of one leg or (rarely) both legs, often to the ankle or foot. Other associated symptoms may be foot drop, or bladder and bowel dysfunction.

Symptoms and signs of nerve root involvement at different spinal levels can assist the general practitioner in identifying the possible nerve root(s) associated with the person’s symptoms and signs.