2. Cervical radicular pain

Abstract

IntroductionCervical radicular pain is pain perceived in the upper limb, caused by irritation or compression of a cervical spine nerve, the roots of the nerve, or both.MethodsThe literature on the diagnosis and treatment of cervical radicular pain was retrieved and summarized.ResultsThe diagnosis is made by combining elements from the patient's history, physical examination, and supplementary tests. The Spurling and shoulder abduction tests are the two most common examinations used to identify cervical radicular pain. MRI without contrast, CT scanning, and in some cases plain radiography can all be appropriate imaging techniques for nontraumatic cervical radiculopathy. MRI is recommended prior to interventional treatments. Exercise with or without other treatments can be beneficial. There is scant evidence for the use of paracetamol, nonsteroidal anti‐inflammatory drugs, and neuropathic pain medications such as gabapentin, pregabalin, tricyclic antidepressants, and anticonvulsants for the treatment of radicular pain. Acute and subacute cervical radicular pain may respond well to epidural corticosteroid administration, preferentially using an interlaminar approach. By contrast, for chronic cervical radicular pain, the efficacy of epidural corticosteroid administration is limited. In these patients, pulsed radiofrequency treatment adjacent to the dorsal root ganglion may be considered.ConclusionsThere is currently no gold standard for the diagnosis of cervical radicular pain. There is scant evidence for the use of medication. Epidural corticosteroid injection and pulsed radiofrequency adjacent to the dorsal root ganglion may be considered. [Correction added on 12 June 2023, after first online publication: The preceding sentence was corrected.]

Update of evidence‐based interventional pain medicine according to clinical diagnoses: Cervical radicular pain response to Helm et al.

“…Laurens Peene MD, FIPP 1 Steven P. Cohen MD, FIPP 2 Brigitte Brouwer MD, PhD 3 James Rathmell MD, FIPP 4 Andre Wolff MD, PhD, FIPP 5 Koen Van Boxem MD, PhD, FIPP 1,3 Jan Van Zundert MD, PhD…”

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We sincerely thank Helm et al for their valuable comments on our review article. 1,2 As the authors note, it is important to report on very rare, albeit disastrous complications of interventional pain management procedures such as cervical interlaminar epidural corticosteroid injections. Epidural hematoma is a recognized risk of this procedure, and the authors are correct to state that the epidural venous plexus potentially lies in the needle path of the interlaminar approach.

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Investigation of Functional Disability, Pain, And Quality of Life in Patients with Cervical Radiculopathy by Gender

“…Causes of cervical radiculopathy vary depending on age. While disc herniations and acute damage are frequently responsible in the young population, foraminal changes due to osteophyte and spondylosis are frequently responsible in older ages (8).…”

Current practices of cervical epidural block for cervical radicular pain: a multicenter survey conducted by the Korean Pain Society

“…Cervical epidural block (CEB) is frequently performed on patients with cervical radicular pain unresponsive to conservative treatments, including exercise therapy and medication [ 1 ]. CEB can be performed by using an interlaminar (IL) or transforaminal approach [ 2 ], with the IL approach being most commonly used due to the risk of major neurologic complications associated with the transforaminal approach [ 1 ]. CEB can be performed using either landmark-based or fluoroscopic guidance, with fluoroscopic guidance being the standard method.…”