Pain patterns and descriptions in patients with radicular pain: does the pain necessarily follow a specific dermatome?
Two pages on PainSci cite Murphy 2009: 1. The Complete Guide to Low Back Pain 2. The Complete Guide to Neck Pain & Cricks
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
BACKGROUND: It is commonly stated that nerve root pain should be expected to follow a specific dermatome and that this information is useful to make the diagnosis of radiculopathy. There is little evidence in the literature that confirms or denies this statement. The purpose of this study is to describe and discuss the diagnostic utility of the distribution of pain in patients with cervical and lumbar radicular pain.
METHODS: Pain drawings and descriptions were assessed in consecutive patients diagnosed with cervical or lumbar nerve root pain. These findings were compared with accepted dermatome maps to determine whether they tended to follow along the involved nerve root's dermatome.
RESULTS: Two hundred twenty-six nerve roots in 169 patients were assessed. Overall, pain related to cervical nerve roots was non-dermatomal in over two-thirds (69.7%) of cases. In the lumbar spine, the pain was non-dermatomal in just under two-thirds (64.1%) of cases. The majority of nerve root levels involved non-dermatomal pain patterns except C4 (60.0% dermatomal) and S1 (64.9% dermatomal). The sensitivity (SE) and specificity (SP) for dermatomal pattern of pain are low for all nerve root levels with the exception of the C4 level (Se 0.60, Sp 0.72) and S1 level (Se 0.65, Sp 0.80), although in the case of the C4 level, the number of subjects was small (n = 5).
CONCLUSION: In most cases nerve root pain should not be expected to follow along a specific dermatome, and a dermatomal distribution of pain is not a useful historical factor in the diagnosis of radicular pain. The possible exception to this is the S1 nerve root, in which the pain does commonly follow the S1 dermatome.
related content
- “Anatomic issues related to cervical and lumbosacral radiculopathy,” Goldstein, Phys Med Rehabil Clin N Am, 2002.
- “The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine,” Tanaka et al, Spine (Phila Pa 1976), 2000.
- “Do L5 and s1 nerve root compressions produce radicular pain in a dermatomal pattern?,” Taylor et al, Spine (Phila Pa 1976), 2013.
- “Symptom provocation of fluoroscopically guided cervical nerve root stimulation. Are dynatomal maps identical to dermatomal maps?,” Slipman et al, Spine (Phila Pa 1976), 1998.
- “Exploration of sensory impairments associated with C6 and C7 radiculopathies,” Rainville et al, Spine J, 2016.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
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