Neuropathic Causes of Spine Related Leg Pain

The term neuropathic relates to pain of a nerve related origin. Neuropathic causes of pain occur when a nerve root becomes irritated. This can be due to a lumbar disc herniation, compression, or inflammation around the nerve.

In this blog we will explore 2 types of neuropathic causes of spine related lower leg pain.

Sciatica:

When looking a spine related leg pain, the common condition that most people are familiar with is sciatica. Sciatica tends to be somewhat of an ‘umbrella’ term, or throw away term, for all sources of leg pain.

43% of people will experience sciatic related leg pain in their lifetime, with 2-3% of the UK population being diagnosed each year. There can often be a poor outcome with this condition, leading to long term pain. This may be due to poor initial management and lack of healthcare providers setting realistic expectations of recovery.

Pain may be ‘radicular’, which is characterised by sharp, shooting, lancinating pain down the leg. 85% of people also report non painful sensory symptoms, such as:

–         Numbness (in 94% of cases)

–         Pins & Needles

–         Cramping

–         Tingling

When radicular pain and these sensory symptoms are both present, we can refer to it as a painful radiculopathy.

These types of sensory symptoms are less common in somatic pain presentations (as discussed in the last blog post), and so can help the professional with their assessment. Painful and sensory symptoms tend to be experienced much further down the leg than with somatic pain. 51% of people report pain in the calf, and 39% report pain in the foot.

Ideally, the diagnosis of neuropathic pain should be diagnosed clinically without having to rely on imaging, unless there are any concerning symptoms, i.e. red flag symptoms or symptoms such as foot drop.

We know that 40% of MRI scans will show no compression even in the event of nerve root compression, and often people who get early MRI’s take longer to recover than those who do not. The management/rehabilitation will likely be the same regardless, but those who have scans often display more fearful behaviour towards rehab and recovery.

Clinically, there are signs and symptoms that aid diagnosis, such as:

–         Lower leg pain being greater than back pain.

–         Pain below the knee.

–         Painful neurological testing.

–         The pain is experienced down one leg.

This condition often gets better with time, although it is normal for it to take a while:

–         90% are thought to improve within 4 months.

–         50% are reported to be fully recovered in 12
weeks.

–         71-74% are better within 12 months.

–         However 1 in 3 still experience symptoms after 1
year.

 

Lumbar Spinal Stenosis

Lumbar spinal stenosis is an age-related condition brought about by normal age related changes around the spinal column. 60% of cases involve people over the age of 65 years. Only 1 in 10 people with these spinal changes report symptoms.

Symptoms that are often observed are:

–         Cramping, aching, heaviness in the legs above
the knees.

–         Pain is worse when standing/walking.

–         Pain improves with lumbar flexion/sitting down.

–         It is not unusual to experience weakness in the
leg muscles and feeling unsteady on feet.

–         Pain is often experienced down both legs.

If the symptoms are moderate then there is generally chance of a good outcome, with 1 in 3 experiencing improvements with walking. 33-50% of people will have symptoms that remain steady, or improve.

What we find with lumbar spinal stenosis is that on imaging, the degree of structural change rarely correlates with clinical findings. Therefore imaging is only really warranted for:

–         Cases that don’t improvement with after
following a good period of rehabilitation.

–         If unable to walk 100m

–         If there is any concern of a sinister
involvement.

Often people may opt for surgery to help with lumbar spinal stenosis. Surgery can have good early success, however 1 in 3 have low satisfaction of results post procedure. 15% of people may need a re-op within 4 years, and 40% of people still experience pain and walking issues post-surgery.

We know from studies, that the follow factors are linked to a worse outcome with surgery and rehabilitation:

–         Smokers

–         A negative outlook on recovery

–         Worse metabolic health.

Hopefully you have found this an interesting and informative read. If you are experiencing pain that sound familiar to what has been discussed above, please reach out HERE, I would be happy to chat through with you and see if you may benefit with some help.