Cervical Radicular Pain

EVIDENCE BASED MEDICINE

Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
4. Cervical Radicular Pain
Jan Van Zundert, MD, PhD, FIPP*†; Marc Huntoon, MD ‡ ; Jacob Patijn, MD, PhD † ; Arno Lataster, MSc § ; Nagy Mekhail, MD, PhD, FIPP ¶ ; Maarten van Kleef, MD, PhD, FIPP †
*Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium; † Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, the Netherlands; § Department of Anatomy and Embryology, Maastricht University, Maastricht, the Netherlands; ‡ Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A.; ¶ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Correspondence to Jan Van Zundert, MD, PhD, FIPP, Ziekenhuis Oost-Limburg, Genk, Multidisciplinary Pain Centre, Stalenstraat, 2, 3600 Genk, Belgium. E-mail: jan.van.zundert@zol.be.
Pain Practice


Published Online: 5 Oct 2009

Journal compilation © 2009 World Institute of Pain


ABSTRACT

Cervical radicular pain is defined as pain perceived as arising in the arm caused by irritation of a cervical spinal nerve or its roots. Approximately 1 person in 1,000 suffers from cervical radicular pain. In the absence of a gold standard, the diagnosis is based on a combination of history, clinical examination, and (potentially) complementary examination. Medical imaging may show abnormalities, but those findings may not correlate with the patient's pain. Electrophysiologic testing may be requested when nerve damage is suspected but will not provide quantitative/qualitative information about the pain. The presumed causative level may be confirmed by means of selective diagnostic blocks. Conservative treatment typically consists of medication and physical therapy. There are no studies assessing the effectiveness of different types of medication specifically in patients suffering cervical radicular pain. Cochrane reviews did not find sufficient proof of efficacy for either education or cervical traction. When conservative treatment fails, interventional treatment may be considered. For subacute cervical radicular pain, the available evidence on efficacy and safety supports a recommendation (2B+) of interlaminar cervical epidural corticosteroid administration. A recent negative randomized controlled trial of transforaminal cervical epidural corticosteroid administration, coupled with an increasing number of reports of serious adverse events, warrants a negative recommendation (2B−). Pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is a recommended treatment for chronic cervical radicular pain (1B+). When its effect is insufficient or of short duration, conventional radiofrequency treatment is recommended (2B+). In selected patients with cervical radicular pain, refractory to other treatment options, spinal cord stimulation may be considered. This treatment should be performed in specialized centers, preferentially study related.