I get a lot of patients who say thay have a pinched nerve either in their backs or in their necks. They are invariably on pain-killers and some of them even have had surgery for their pinched nerves. As there is a lot of confusion and misperception in the minds of patients when it comes to “pinched nerves” I thought this might be a good time to discuss this topic.
So what exactly is a “pinched nerve”? When patients say they have a pinched nerve, they are referring to what we as neurologists call “radiculopathy”. Let me try to explain this in simple terms. The nerves that supply the muscles of the arms and legs come out from the spinal cord. These nerves exit as small nerve rootlets (radicles) from inbetween the bones that make the vertebral column (spine). At times these nerve rootlets (radicles) may be compressed (pinched) by either a bony spur of the vertebral column or a disk might herniate out and compress the nerve rootlet. This compression of the nerve (radicle) leads to pain which characteristically radiates down along the length of the nerve. So for example if you have a pinched nerve in the neck, the pain shall radiate down your arm and if you have a pinched nerve in the back, the pain shall radiate down your leg. This is what is called RADICULOPATHY.
The pain of radiculopathy can be excrutiating causing much discomfort and distress. In the acute stage, patient may find it so painful that they cannot move. They complain of “current” running down their arm or leg.
So how do we treat a pinched nerve? Well in the acute stage (when the nerve is inflammed), bed-rest is prescribed. This may vary anywhere from 3 days to a week. The acute pain of a radiculopathy is treated with painkillers–these may range from simple analgesics like Tylenol to anti-inflammatory drugs like Motrin, Advil and even corticosteroids for a short duration. Other medications used include medications effective against neuropathic pain such as gabapentin (Neurontin) and carbamazepine (Tegretol).
Recent studies have shown than most radiculopathies shall settle down over time with the above conservative measures. At times a disectomy is carried out (removal of the herniated disk) for pain relief. Epidural steroid injections may provide temporary relief.
BUT AS I STATED EARLIER MOST RADICULOPATHIES (PINCHED NERVES) SHALL SETTLE DOWN WITH CONSERVATIVE MANAGEMENT.
Nitin Sethi, MD