Is lower back pain that radiates to the hip considered radiculopathy (radicular pain)?

From the Guidelines

Lower back pain that radiates to the hip is not necessarily radicular pain, and a thorough evaluation by a healthcare provider is necessary to determine the cause of the pain. Radicular pain specifically refers to pain that travels along the path of a spinal nerve root, typically caused by compression or irritation of that nerve root. True radicular pain usually extends beyond the hip and travels down the leg following a specific nerve distribution pattern (like the sciatic nerve), often accompanied by neurological symptoms such as numbness, tingling, or weakness. Pain that simply radiates from the lower back to the hip area is more likely referred pain, which occurs when pain from one area is perceived in another connected area. This referred pain is commonly caused by muscle strains, joint dysfunction, or other soft tissue injuries in the lower back that refer pain to the hip region through shared nerve pathways.

Key Points to Consider

• The diagnosis of radiculopathy involves assessing for pain, sensory impairment, weakness, or diminished deep tendon reflexes in a nerve root distribution, as defined by the American College of Physicians and the American Pain Society 1.
• Imaging studies, such as MRI or CT scans, may be necessary to confirm the diagnosis of radiculopathy or to rule out other underlying conditions, but are not typically recommended for initial evaluation of acute low back pain without red flags 1.
• A thorough physical examination and medical history are essential to determine the cause of the pain and to develop an effective treatment plan.
• Treatment approaches differ depending on whether the patient is experiencing true radicular pain or referred pain, so accurate diagnosis is crucial for effective management.

Recommendations for Evaluation and Treatment

• Clinicians should conduct a focused history and physical examination to help place patients with low back pain into one of three broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause 1.
• Imaging studies should be reserved for patients with severe or progressive neurologic deficits, or when serious underlying conditions are suspected on the basis of history and physical examination 1.
• Patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis should be evaluated with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection 1.

From the Research

Definition of Radiculopathy

• Radiculopathy, also known as radicular pain, is caused by irritation of the sensory root or dorsal root ganglion of a spinal nerve 2.
• This irritation leads to ectopic nerve impulses perceived as pain in the distribution of the axon.

Characteristics of Radiculopathy

• Radicular pain is sharp, shooting, or lancinating, and is typically felt as a narrow band of pain down the length of the leg, both superficially and deep 2.
• It may be associated with radiculopathy (objective sensory and/or motor dysfunction as a result of conduction block) and may coexist with spinal or somatic referred pain 2.
• Lower limb pain, including thigh pain, hip pain, and knee pain, can be characteristics of radiculopathy, particularly L3 nerve root radiculopathy 3.

Lower Back Pain Radiating to the Hip

• Lower back pain that radiates to the hip can be considered radiculopathy if it is caused by irritation of the sensory root or dorsal root ganglion of a spinal nerve 2.
• However, it is also possible for lower back pain with radiation to the lower extremities to be caused by a referred type of pain unrelated to direct nerve root compression or irritation by a disk fragment in the epidural space 4.
• A diagnosis of radiculopathy should be based on a combination of history, clinical examination, and additional investigations, such as medical imaging studies and selective diagnostic nerve root blocks 5.

Treatment of Radiculopathy

• Treatment options for radiculopathy include simple analgesics, transforaminal epidural steroid injection, and surgery 2.
• Neural mobilization (NM) may also be an effective tool for short-term improvements in pain, function, and disability associated with radiculopathy 6.
• In chronic cases, pulsed radiofrequency (PRF) treatment adjacent to the spinal ganglion (DRG) can provide pain relief for a longer period in well-selected patients 5.