The Diagnosis & Treatment of Radiculopathy Compared to Neuropathy

Jenny L.F. Andrus, MD

Diagnosis of Radiculopathy (pain that originates in the nerves emerging from the spinal cord)

I’ll typically diagnose radiculopathy through a combination of reading notes from your prior physician visits, reviewing and imaging studies, such as MRI or CT scans that may have been taken, getting your patient history and doing a complete physical examination. Expect me to ask a lot of questions!  I may also order and perform tests called Electromyography (EMG) and nerve conduction studies which can help assess the extent of any nerve damage. 

Diagnosis of Neuropathy (pain that originates from nerves outside of the brain and spinal cord)

Diagnosis involves you providing me with a detailed medical history and the clinical notes from prior physician visits.  I will complete a very thorough physical examination. Blood tests can help identify underlying conditions, such as diabetes or some autoimmune issues.  I may order and perform EMG and nerve conduction studies to assess if your nerves’ function and fire properly.

Treatment of Radiculopathy

Conservative Treatments:

• Medications – Nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen sodium, muscle relaxants, and oral corticosteroids are often used alone or in combination to reduce inflammation and pain
• Physical Therapy – Exercise and therapeutic modalities, like traction, are often prescribed to strengthen the muscles supporting the spine, improve range of motion and to reduce inflammation, pain, numbness and tingling. Transcutaneous electrical nerve stimulation (TENS) units may often be prescribed for relief.
• Lifestyle Modifications – Patients are often asked to lose weight, exercise at home and to make ergonomic adjustments to their workstations/places.

Lifestyle and Supportive Therapies:

• Physical Therapy – Exercises have been proven to improve muscle strength, coordination and will often quickly improve or make the problem worse, which serves to confirm the diagnosis.
• Assistive Devices – when necessary, braces, orthotic devices, or walkers and canes can enhance mobility and function.
• Pain Management Techniques:
  • Cognitive Therapy for Pain
  • Meditation/Mindfulness
  • Acupuncture
  • Biofeedback

Interventional Procedures

• Epidural Steroid Injections: Corticosteroids injected into the epidural space to reduce inflammation and pain of the compromised nerve
• Nerve Blocks: Anesthetic injections to block pain signals to the brain
• Radiofrequency Ablation: The myelin sheath (which carries pain signals to the brain) is burned off the offending nerve. When it grows back 6-12 months later, often pain is gone or greatly reduced. 

Surgery

Reserved for severe cases where conservative treatments fail, surgical options include discectomy (removal of herniated disc material) or laminectomy (removal of part of the vertebra to relieve pressure) or spinal fusion, where the spinal disc is removed, and hardware is added for stability until the spinal bones fuse together (called union).

Treatment of Neuropathy

1. Addressing Underlying Conditions

• Diabetes Management: Tight blood sugar control and proper nutrition to prevent further nerve damage.
• Nutritional Support: Addressing deficiencies in vitamins like B12.

2. Medications:

• Pain Relievers: NSAIDs (ibuprofen or naproxen sodium) or acetaminophen. However, these have not proven to be effective for severe or chronic nerve pain and should only be taken for two weeks maximum at maximum dosages.  Patients who do not follow dosing guidelines may harm their digestive tracks, liver or kidneys due to toxicity.
• Vitamin B12 Injections – There is evidence that some nerve pain can be caused or worsened by this vitamin deficiency. Vitamin B12 injections may help.
• Oral prescription steroid medications
• Antidepressants (amitriptyline, Cymbalta™) and Anticonvulsant drugs like, gabapentin, or pregabalin can help turn down nerve pain
• Topical Treatments: Capsaicin cream or lidocaine patches can be helpful 

3. Lifestyle and Supportive Therapies:

• Physical Therapy – Exercises to improve muscle strength, balance and coordination are very important. Because lack of feeling or hypersensitivity may be an issue, modalities must be used with care. Transcutaneous electrical nerve stimulation (TENS) units may be prescribed.
• Assistive Devices – Braces, orthotic devices, or walking aids can be used to increase function and enhance mobility.
• Pain Management Techniques – Acupuncture, biofeedback, or
• Electrical Cell Stimulation Therapy

4. Interventional Procedures:

• Nerve Blocks – Injections to block pain signals from going to the brain
• Radiofrequency Ablation– The myelin sheath (which carries pain signals to the brain) is burned off the offending nerve. When it grows back 6-12 months later, often pain is gone or greatly reduced.
• Neurostimulation or Electric Spinal Cord Stimulation – Small leads are placed in the epidural space and attached to a battery that generates electrical signals that override pain signals going to the brain. This is a permanent implant that can be adjusted and turned off/on by the patient.