Lumbosacral Radicular Pain

Abstract

Introduction: Patients suffering lumbosacral radicular pain report radiating pain in one or more lumbar or sacral dermatomes. In the general population, low back pain with leg pain extending below the knee has an annual prevalence that varies from 9.9% to 25%. Methods: The literature on the diagnosis and treatment of lumbosacral radicular pain was reviewed and summarized. Results: Although a patient's history, the pain distribution pattern, and clinical examination may yield a presumptive diagnosis of lumbosacral radicular pain, additional clinical tests may be required. Medical imaging studies can demonstrate or exclude specific underlying pathologies and identify nerve root irritation, while selective diagnostic nerve root blocks can be used to confirm the affected level(s). In subacute lumbosacral radicular pain, transforaminal corticosteroid administration provides short-term pain relief and improves mobility. In chronic lumbosacral radicular pain, pulsed radiofrequency (PRF) treatment adjacent to the spinal ganglion (DRG) can provide pain relief for a longer period in wellselected patients. In cases of refractory pain, epidural adhesiolysis and spinal cord stimulation can be considered in experienced centers. Conclusions: The diagnosis of lumbosacral radicular pain is based on a combination of history, clinical examination, and additional investigations. Epidural steroids can be considered for subacute lumbosacral radicular pain. In chronic lumbosacral radicular pain, PRF adjacent to the DRG is recommended. SCS and epidural adhesiolysis can be considered for cases of refractory pain in specialized centers.

Optical Detection of Vascular Penetration During Nerve Blocks

“…The optical stylet used in this study could, in principle, be modified to accommodate different needle cannula geometries; as such, it could potentially be used to detect intravascular needle placement across a broad range of interventional pain management and regional anesthesia procedures. Additional sources of contrast would be valuable to further reduce the risk of intravascular injections in transforaminal epidural steroid injections, where anatomic variation of the arteries is of concern (eg, the artery of Adamkiewicz for lumbar and thoracic injections, 22,23 and the vertebral and cervical arteries for cervical injections 24 ).…”

Low back pain

“…Pulsed radiofrequency is applied with temperature limitation at 42 o Celsius and exposure time of at least 120 seconds 37,38 . b) Spinal cord stimulation In patients with pharmacological treatment limitation and insatisfactory response to percutaneous interventionist treatment, the surgical option is spinal electrode implant to stimulate spinal cord above the conus.…”

Spinal Cord Stimulation (SCS) and Functional Magnetic Resonance Imaging (fMRI): Modulation of Cortical Connectivity With Therapeutic SCS

“…Neuropathic pain is defined as "pain initiated or caused by a primary lesion or dysfunction in the nervous system" (1,2). Chronic neuropathic leg pain is the most common form of neuropathic pain with an estimated annual prevalence between 9.9% and 25% in the general population (3,4). According to the International Association for Study of Pain (IASP), the diagnostic criterion for complex regional pain syndrome (CRPS) type 1 includes the presence of disproportionate persistent pain with allodynia or hyperalgesia; presence of inciting noxious event or immobilization; presence of edema, changes in blood flow, or abnormal sudomotor activity in the region of the pain; absence of obvious cause of the degree of pain and dysfunction (5).…”