Radiculalgia is pain of nervous origin. This pain is called radicular since it affects the root of the nerves. This condition is commonly caused by the compression of a spinal nerve (attached to the spine) at its root. Such compression may be the result of osteoarthritis of the spine, a herniated disc or even a bone or nerve tumor. Etymologically, the term radiculalagie is formed from the Latin “radicula”, diminutive of radix which means root, and from 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 disturbances of sensitivity.

Multifactorial pain

Radiculalgia is, in fact, multifactorial: it combines both mechanical and chemical factors. The most common mechanical factors are strain, such as lifting a heavy load, false movement such as twisting of the body. As for the most frequent chemical factors, they involve the simple contact of the nerve with the 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 radical pain

The diagnosis of radiculalgia is based on neuroimaging (computed tomography or magnetic resonance imaging) of the affected area. Sometimes it is necessary to perform electrophysiological examinations as well. If the imaging did not detect any anatomical abnormality, the analysis of the cerebrospinal fluid will make it possible to look for infectious or inflammatory causes. In addition, fasting blood sugar will also be studied for possible diabetes.

Root canal disorders are caused by chronic or acute hypertension that affects a nerve root in or near the spine. The pain thus comes, most often, from the compression of this nerve root at the level of a vertebra, and it can be caused by:

• a herniated 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 individual nerve roots. Thus, wear of the intervertebral disc caused by osteoarthritis, for example, can result in radiculalgia;
• a narrowing of the spinal canal located 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.

First cause of radiculalgia: herniated disc

A herniated disc is the number one cause of root 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 additionally, radiculalgia could be caused by an inflammatory or immune component that can occur with a herniated disc. The results of a scientific study showed that changes in peripheral blood T cell subsets occur as a result of prolapse of lumbar invertebrate discs. The study authors concluded that immunologic mechanisms are likely to be involved in the pain associated with a herniated disc. In addition, an increase in certain cytokines could also contribute to radicular pain.

The most common symptoms of radiculalgia are:

• very frequently acute pain;
• tingling, numbness, tingling;
• weakness of limbs or even paralysis;
• anesthesia of the skin;
• in addition, coughing, sneezing, or pushing can make the pain worse.

Treating chronic pain is complex, with paracetamol and steroidal anti-inflammatory drugs often only partially effective and prolonged use of NSAIDs representing a significant risk.

The treatment of radiculalgia aims both to relieve the pain and to limit the handicap it induces. The treatment is based above all on drug treatment, as well as rehabilitation by a physiotherapist who will relieve spinal tension.

Drug treatments

• Analgesics (painkillers): often, paracetamol, a stage I analgesic, is insufficient. It can therefore be combined with caffeine, codeine or even tramadol. As for morphines (level III analgesics), they should be used sparingly, and reserved for hyperalgesic radiculalgia;
• Nonsteroidal anti-inflammatory drugs (NSAIDs): ketoprofen, diclofenac, naproxen are often prescribed in combination with step II analgesics. Their pain-relieving effect is not superior to analgesics alone. They should not be used for more than ten days to two weeks. If the pain recurs after stopping for a few days, they can be prescribed for a longer period of time;
• Antiepileptics: pregabalin, gabapentin and pregabapentin 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 against pain. They are issued over a short period of seven to ten days. They can also be administered by infiltration, which makes it possible to deliver a high concentration of active product to the pain level. They are indicated essentially 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 orthopedic technician. In plastic, leather and steel, even plaster or resin, the lumbar stat allows relative immobilization of the lumbar vertebrae, by means of a support which extends from the side of the pelvis to the last ribs. Its action is to achieve a lumbar blockage by securing the trunk to the pelvis. Concretely, it thus makes it possible to avoid false movements as well as to ensure a rest of the back. In addition, it decreases the stresses exerted on the vertebrae;
• Rehabilitation: Rehabilitation sessions by the physiotherapist help relieve tension in the vertebrae, and allow re-training to effort in order to put your back back on its feet. Even in pain, it is very important to remain mobile and active. The goal of this training is to strengthen its muscles, improve its physical capacities, and the exercises practiced range from cycling to running, including sheathing, abdominal exercises, etc;
• Yoga and swimming: the practice of these two sports will relax the spine, but also relieve muscle contractures;
• Osteopathy: it helps reduce 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 release techniques;
• Surgery: it can be used as a last resort.

Prevention of radiculalgia

In order to prevent radiculalgia, a few tips should be remembered, such as:

• avoid twisting movements of the trunk when you want to catch something that is behind you;
• favor backpacks over handbags and use both shoulders to carry the backpack;
• or adopting a good position while sleeping, in particular by having a comfortable mattress as well as a pillow that does not create an excessively large angle at the level of the neck.

Alternative therapies

• Transcutaneous electrical neurostimulation;
• Thermotherapy;
• Acupuncture ;
• Relaxation and meditation: these two methods make it possible to play down the fears that lead to the fear of movement, but also to relieve anxiety and stress related to pain.