Simon Vulfsons1,2, Negev Bar3,4, Elon Eisenberg5,6. 1. Institute for Pain Medicine, Rambam Health Care Campus, 11 Ephron Street, Bat Galim, 3109601, Haifa, Israel. s_vulfsons@rambam.health.gov.il. 2. Rappaport Faculty of Medicine, Technion Institute for Technology, Haifa, Israel. s_vulfsons@rambam.health.gov.il. 3. Department of Family Medicine, Haifa, Israel. 4. Clalit Health Services, Haifa, Haifa and Western Galilee, Israel. 5. Institute for Pain Medicine, Rambam Health Care Campus, 11 Ephron Street, Bat Galim, 3109601, Haifa, Israel. 6. Rappaport Faculty of Medicine, Technion Institute for Technology, Haifa, Israel.
Abstract
PURPOSE OF REVIEW: The clinical diagnostic dilemma of low back pain that is associated with lower limb pain is very common. In relation to back pain that radiates to the leg, the International Association for the Study of Pain (IASP) states: "Pain in the lower limb should be described specifically as either referred pain or radicular pain. In cases of doubt no implication should be made and the pain should be described as pain in the lower limb." RECENT FINDINGS: Bogduks' editorial in the journal PAIN (2009) helps us to differentiate and define the terms somatic referred pain, radicular pain, and radiculopathy. In addition, there are other pathologies distal to the nerve root that could be relevant to patients with back pain and leg pain such as plexus and peripheral nerve involvement. Hence, the diagnosis of back pain with leg pain can still be challenging. In this article, we present a patient with back and leg pain. The patient appears to have a radicular pain syndrome, but has no neurological impairment and shows signs of myofascial involvement. Is there a single diagnosis or indeed two overlapping syndromes? The scope of our article encompasses the common diagnostic possibilities for this type of patient. A discussion of treatment is beyond the scope of this article and depends on the final diagnosis/diagnoses made.
PURPOSE OF REVIEW: The clinical diagnostic dilemma of low back pain that is associated with lower limb pain is very common. In relation to back pain that radiates to the leg, the International Association for the Study of Pain (IASP) states: "Pain in the lower limb should be described specifically as either referred pain or radicular pain. In cases of doubt no implication should be made and the pain should be described as pain in the lower limb." RECENT FINDINGS: Bogduks' editorial in the journal PAIN (2009) helps us to differentiate and define the terms somatic referred pain, radicular pain, and radiculopathy. In addition, there are other pathologies distal to the nerve root that could be relevant to patients with back pain and leg pain such as plexus and peripheral nerve involvement. Hence, the diagnosis of back pain with leg pain can still be challenging. In this article, we present a patient with back and leg pain. The patient appears to have a radicular pain syndrome, but has no neurological impairment and shows signs of myofascial involvement. Is there a single diagnosis or indeed two overlapping syndromes? The scope of our article encompasses the common diagnostic possibilities for this type of patient. A discussion of treatment is beyond the scope of this article and depends on the final diagnosis/diagnoses made.
Entities:
Keywords:
Back pain; Leg pain; Neuralgia; Radicular pain; Sciatica; Somatic referred pain
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