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WHAT IS LUMBAR RADICULAR PAIN?

Lumbar radiculopathy is one of the most common patient complaints. In fact,  three to five percent  of the population complain of lumbar radicular pain, and even more people struggle with the pain in silence.

From spine surgeons to pain management physicians, these patients often become frustrated as they have no understanding of what’s happening. It is imperative for these patients to understand what lumbar radicular pain is and what the common treatments are.

WHAT IS LUMBAR RADICULAR PAIN?

Lumbar radiculopathy is a kind of disease in the lower spine. More specifically, this condition involves the nerve roots in the lumbar spine. Those with it may experience pain, numbness, and/or weakness in the buttock and/or one of the legs.

Often, people use the term sciatica to refer to lumbar radicular pain.

If the spinal nerve root becomes compressed, this can lead to lumbar radicular pain. This is the most common cause of the condition.

Because of the compression of the nerve, the pain can refer to other areas. Most often, this pain refers to one of the legs.

Delaying care by ignoring the pain can lead to further damage of these nerves and/or nerve roots.

Because lumbar pain is so common, your physician is likely to have seen many cases before. They should be able to help you find the source of the problem and get your pain under control.

WHAT CAUSES LUMBAR RADICULOPATHY?

When the spinal nerve roots become irritated or compressed, lumbar radiculopathy may form. Irritation and/or compression can develop because of mechanical manipulation or result from another condition such as:

  • Lumbar disc herniation
  • Spinal stenosis
  • Osteophyte formation
  • Spondylolisthesis
  • Foraminal stenosis

In fact, many degenerative disorders could cause lumbar radiculopathy.

HOW CAN I GET A DIAGNOSIS FOR LUMBAR PAIN?

You can get a diagnosis from a spinal doctor, a chiropractor, an orthopedic physician, a primary care doctor, or similar specialist. Whoever you see will look over your medical history and give you a physical examination.

While they’re examining you, the physician will look at your spinal range of motion, movement limitations, balance issues, and sensory issues. These sensory issues may include loss of extremity reflexes, muscle weakness, or abnormal reflexes.

The physician may also decide to get an x-ray or MRI to view your spinal structure. However, if you have a contraindication like a pacemaker or a spinal cord stimulator, you may get a CT myelogram instead of an MRI.

WHAT ARE THE SYMPTOMS OF LUMBAR RADICULAR PAIN?

Not every patient’s lumbar pain is the same. But, here are some of the most common complaints associated with lumbar radiculopathy:

  • Pain
  • Tingling
  • Numbness
  • Weakness
  • Loss of reflexes

These kinds of symptoms typically happen in the lower back, buttocks, leg, and foot. The pain can radiate to either leg, but it usually only affects one leg.

If you’re having any of these symptoms, see a doctor as soon as possible. If you continue to use your spine as normal, you could cause more damage. It’s important to get to the root of the problem so that you know you aren’t hurting yourself.

WHAT ARE THE TREATMENTS FOR LUMBAR RADICULOPATHY?

If you’re suffering from lumbar radicular pain, there are a few kinds of treatments that your doctor may mention. These fall into two categories: surgical and non-surgical.

Physicians start out by testing non-surgical techniques unless your results show a strong need for surgery.

Non-Surgical Treatments for Lumbar Radicular Pain

There are a couple of non-surgical options for correcting lumbar pain:

  • Physical therapy
  • Pain management
  • Injections

Your physician may decide that you need one, two, or all three. You could even do all of them at once or try two or three at a time. There is no right or wrong order because it depends on your particular case.

Physical therapy can go through a prescription process or involve you  doing muscle exercises  at home. Either way, the movements that the patient does are meant to stabilize the spine. This can help your body make more room for the spinal nerve roots so that they can decompress. Pain management involves administering medications to someone with lumbar radiculopathy. These can range from non-steroidal anti- inflammatory drugs (NSAIDs) to steroidal medications.

The kinds of medications that your physician recommends will depend on your level of pain and your use of medications in the past. These medications should help reduce swelling and pain.

The injections that you could get include an epidural steroid injection and/or a nerve root injection. These can help reduce swelling and pain that radiates into your hips. It should also be able to help with the pain that radiates down into the leg, no matter which leg the pain is affecting.

Surgical Treatments for Lumbar Radicular Pain

The kinds of surgical treatments that you can have depend on what is causing your lumbar pain. Most of these kinds of surgeries work to decompress the nerve or stabilize the spine.

There are various types of surgical treatments to help alleviate your lumbar radicular pain, including spinal fusion, laminotomy, laminectomy, and microdiscectomy.

These surgeries work to fix deformities in the spine and its nerves. By having the appropriate surgery done, you could find relief from your lumbar radicular pain.

PAIN MANAGEMENT FOR LUMBAR RADICULAR PAIN

Pain management for lumbar radicular pain is important. Whether your physician opts for non-surgical or surgical techniques, you need to get the pain under control before additional problems arise.

If you’re looking for treatment options, our team at Interventional Pain and Spine is here for you. We will customize a treatment plan to get you through your lumbar pain.

Contact us today to make an appointment.

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Steroid Injection Therapy Does Not Compromise COVID-19 Vaccine Efficacy, New Guideline Suggests

The American Society of Pain and Neuroscience (ASPN) issued a new set of recommendations to guide clinicians in the safe and appropriate use of steroid injections for pain management in patients who are receiving the COVID-19 vaccine (J Pain Res 2021;14:623-629).

“The central question that we wanted to deduce and answer is whether a local steroid injection might potentially reduce the efficacy of the COVID-19 vaccine, which relies upon a robust and potent immune response that primes the body to fight the virus,” lead author Krishnan Chakravarthy, MD, PhD, an assistant clinical professor of anesthesiology at the University of California, San Diego, told Pain Medicine News.

“Our conclusion is that, overall, it doesn’t make sense to hold focal steroid therapy from patients in pain out of concern that vaccine efficacy may be compromised, although individual patients may have different needs,” Chakravarthy said.

He added that the committee’s recommendations are “fluid” and noted that they will continue to be updated as new data emerge.

Of note, there is no evidence that patients receiving epidural steroid therapy for the management of pain are at increased risk for adverse outcomes from COVID-19 vaccination.

Epidural steroid injections “represent an integral component of modern-day pain management for many patients,” but they carry a “theoretical risk of immunosuppression from neuraxial steroid administration,” the authors wrote.

A study of IV hydrocortisone administered to healthy adult volunteers resulted in reduced circulation of inflammatory T cells within 48 hours (J Clin Invest 1978;61[3]:703-707). Similarly, an analysis of close to 2,000 serious infection cases in 16,207 patients with rheumatoid arthritis receiving chronic oral glucocorticoids (5 mg) found a 30%, 46% and 100% increased risk for serious infection with continuous treatment for three months, six months or three years, respectively, compared with nonusers (Ann Rheum Dis 2012;71[7]:1128-1133).

Although steroids are systemically absorbed from the epidural space, specific data regarding the efficacy of vaccines in the setting of local steroid injection are “lacking.”

So, “while epidural steroids may be absorbed systemically, based on current dosing strategies and the pharmacodynamics of these injections, they are unlikely to demonstrate the immunosuppressive effects associated with chronic high-dose systemic steroid use,” the authors summarized.

There is no evidence that bolus steroids in the epidural space will affect vaccine responsiveness, according to the recommendations.

Short-term systemic bolus steroids have not been demonstrated to affect vaccine responsiveness in the tetanus or influenza vaccines. Moreover, inhaled steroids “do not appear to affect serologic responsiveness to Hepatitis B vaccination,” the authors stated.

Neuraxial steroid injections do not need to be deferred when indicated in the context of COVID-19 vaccination, according to the recommendations.

Patients with severe immunodeficiency risks (e.g., those undergoing chemotherapy or transplant or who have autoimmune disorders) face decisions regarding vaccine administration versus treatment delay. This dilemma is often determined based on the “perceived severity of the underlying condition for which the patient is receiving steroids.”

Although it may appear that pain treatment, which is elective, is less critical than other immunosuppressive therapies for conditions such as cancer and, therefore, should be delayed until after the pandemic, “this approach does not account for the unique experiences of individual patients and the sense of urgency they feel for achieving pain relief,” Chakravarthy said.

Thus, there is an “ethical component” of the decision: the right of patients to receive effective pain management. This consideration is a component of the “individual and societal trade-offs associated with delays in standard medical care,” which have characterized the COVID-19 pandemic, Chakravarthy noted.

No specific guidance suggests withholding nonsteroidal anti-inflammatory drugs (NSAIDs) or other anti-inflammatories prior to vaccination.

The authors thoroughly reviewed research regarding the potential impact of NSAIDs and cyclooxygenase inhibitors on vaccine efficacy. Some research suggests that all of these agents might blunt antibody production, potentially affecting the immune response required for a successful vaccination. However, “overall, the data are inconclusive and insufficiently robust to draw meaningful conclusions and change potential practice algorithms,” they stated.

Placing the Recommendations In Context

Commenting on the study for Pain Medicine News, Giustino Varrassi, MD, PhD, the president of the Paolo Procacci Foundation, in Rome, and a former president of the World Institute of Pain, said he is “personally grateful to the prestigious authors of the publication.”

In fact, the authors “reconfirm what was already known, the clinical use of corticosteroids does not affect the efficacy of vaccines.” The paper’s contribution “makes clear and provides scientific support to these important concepts,” Varrassi said.

Also commenting on the study for Pain Medicine News, Steven P. Cohen, MD, the director of medical education in the Pain Medicine Division, and a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, in Baltimore, agreed with the conclusions of the guidelines and emphasized the importance of personalized medicine, “whereby the risks and likelihood of benefit are carefully weighed and discussed with the patient.”

Cohen noted that acute pain suppresses the immune system, as do opioids. “Steroids can perhaps prevent the initiation or escalation of opioids,” he said.

Chakravarthy agreed, emphasizing that guidelines are “meant to guide, but we are in an age where individual practice preferences are important, and we ultimately want physicians to use their own individual discretion.”

Each patient will have his or her “particular needs and specific risks and benefits, and these must be taken into account when choosing a treatment course,” Chakravarthy said.

— Batya Swift Yasgur, MA, LSW