From the Guidelines
For evaluating lower extremity unilateral new-onset radiculopathy in clinic, key tests include the straight leg raise test, crossed straight leg raise test, femoral nerve stretch test, motor strength testing, sensory testing, and deep tendon reflex assessment. The most recommended atypical medication for seniors over 65 with radiculopathy is gabapentin, starting at a low dose of 100-300mg at bedtime and gradually titrating up as tolerated to 300mg three times daily 1. Some key points to consider when evaluating lower extremity unilateral new-onset radiculopathy include:
- The straight leg raise test is positive when pain radiates below the knee at 30-70 degrees of elevation
- The femoral nerve stretch test is used for L2-L4 radiculopathy
- Motor strength testing of key muscle groups, such as hip flexors, quadriceps, ankle dorsiflexors, and great toe extensors, is essential
- Sensory testing along dermatomes and deep tendon reflex assessment, including patellar and Achilles reflexes, should also be performed
- Gabapentin and pregabalin (Lyrica) are effective medications for radiculopathy, with gabapentin being the most recommended for seniors over 65 1
- Dosing should be adjusted for renal function, which commonly declines in older adults
- Monitoring for increased fall risk, especially during initial titration, is crucial
- These medications should be used alongside physical therapy and proper body mechanics education for optimal outcomes. It's also important to note that imaging is usually not appropriate for the initial imaging of patients with acute LBP with or without radiculopathy, no red flags, and no prior management, as stated in the American College of Radiology guidelines 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
In-Clinic Tests for LE Unilateral New-Onset Radiculopathy
- Electrodiagnostic (EDX) examination with needle electromyography (EMG) is the most important means of testing for radiculopathy 2
- Needle EMG in combination with nerve conduction testing is valuable in excluding entrapment neuropathies and polyneuropathy-conditions that frequently mimic radicular symptoms 2
- Standard nerve conduction studies, late responses, evoked potentials, and needle electrode examination can be used in the work-up of lumbosacral and cervical radiculopathy 3
- Magnetic resonance imaging (MRI), computerized tomography (CT), contrast myelogram, electromyogram (EMG), and nerve conduction velocity (NCV) are involved in the diagnosis and decision-making 4
Best Recommended Atypical or Off-Label Medication for 65+ Seniors
- Pregabalin (PGB) and gabapentin (GBP) can be equally used to reduce pain in lumbar radiculopathy patients who underwent transforaminal epidural steroid injection 5
- PGB showed statistically significant improvement in pain scale (VAS and NRS) in short-term follow-up (6 weeks or less) compared to GBP 6
- However, in the long-term follow-up (6 weeks to 12 weeks), there was no difference in pain reduction effect between two groups 6
- The incidence of adverse events (dizziness and sedation) showed no difference between PGB and GBP groups 6