Face / Head / Neck

Cervical Radicular Pain in Disc Prolapse

Definition

According the classification of the International Association for the Study of Pain (IASP), cervical radicular pain is defined as pain observed as originating in the upper extremities and is caused by ectopic activation of nociceptive afferent fibres in a spinal nerve or root or other neuropathic mechanisms. This definition presents a problem because ectopic activation of nociceptive afferent fibres has seldom or never been proved in a clinical setting.

Cervical radicular pain must be distinguished from cervical radiculopathy. In cervical radiculopathy, there is an objective deficit of sensory and/or motor function. Although both terms are used interchangeably in the literature, radicular pain and radiculopathy are not synonymous. Radicular pain is a symptom caused by ectopic impulses, while radiculopathy comprises neurological signs such as sensory and motor changes.  Radicular pain and radiculopathy can occur at the same time.

Aetiology

The pain is caused by compression of the nerve root by the prolapse of an intervertebral disc.

Signs and symptoms

Cervical radicular pain is characterised by pain starting in the neck, and irradiating to the dorsal side of the shoulder, the dorsal lateral side of the upper arm, and the hand. The irradiating pain has a typical segmental pattern. Pain in various dermatomes can overlap, and no specific region of the arm is characteristic of a specific root segment. Radicular pain is not restricted to a particular dermatome and can be observed in all structures innervated by the affected nerve root, such as muscles, joints, ligaments and the skin.

Diagnostics

Physical Examination

As in most pain syndromes, there is no gold standard available for diagnosing cervical radicular pain. For that reason, the diagnosis is made based on a combination of medical history, neurological examination and additional diagnostics. The neurological examination consists of testing sensibility, strength and tendon reflexes. Tests for radicular provocation are as follows: neck compression test or Spurling test, shoulder abduction test, and axial manual traction test.

Additional Somatic Diagnostics

Additional Psycho-cognitive Diagnostics

  • RAND-36 (quality of life)
  • VAS-Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis.  Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment comprising various non-somatic treatments may be necessary.

Additional Somatic Diagnostics

Additional Psycho-cognitive Diagnostics

  • RAND-36 (quality of life)
  • VAS-Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis.  Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment comprising various non-somatic treatments may be necessary.

Non-somatic Treatment

Somatic Treatment

Pharmacological treatment:

  • Non-steroid anti-inflammatories (short period)
  • Tricyclic antidepressants
  • Anticonvulsiva: carbamazepine, oxcarbazepine, gabapentine en pregabaline.

Interventional Pain Treatment