Treatment for Nerve Pain in Left Hand Due to Cervical Compression
Begin with a minimum 6-week trial of structured conservative management, as 75-90% of patients with cervical radiculopathy achieve symptomatic improvement without surgery. 1, 2
Immediate Conservative Treatment Protocol
Your initial approach should consist of the following multimodal regimen:
- Cervical immobilization with a rigid collar for short-term use to reduce nerve root irritation 1, 2
- NSAIDs (anti-inflammatory medications) to address both nerve root inflammation and facet joint inflammation 1, 2
- Physical therapy including cervical traction to temporarily decompress nerve impingement 1, 2
- Activity modification with avoidance of provocative movements that exacerbate radicular symptoms 1, 2
Do NOT rush to imaging at initial presentation unless red flag symptoms are present (progressive motor weakness, bowel/bladder dysfunction, fever, unexplained weight loss), as most acute cervical radiculopathy resolves spontaneously or with conservative treatment. 2
Medication Options for Neuropathic Pain
While evidence for neuropathic pain medications in cervical radiculopathy is limited 3, consider:
- Gabapentin: Start 300 mg once daily on Day 1, increase to 300 mg twice daily on Day 2, then 300 mg three times daily on Day 3. Can titrate up to 1800 mg/day (600 mg three times daily) for pain relief. 4
- Pregabalin: Start 75 mg twice daily (150 mg/day), can increase to 150 mg twice daily (300 mg/day) within 1 week based on efficacy and tolerability. 5
Note that there is scant evidence for paracetamol, NSAIDs, gabapentin, pregabalin, tricyclic antidepressants, and anticonvulsants specifically for radicular pain. 3
When to Obtain Imaging
If symptoms persist beyond 6 weeks of conservative management, obtain imaging:
- MRI cervical spine without contrast is the preferred initial imaging modality, correctly predicting 88% of lesions causing cervical radiculopathy and providing superior visualization of disc herniations and nerve root compression. 6, 1, 2
- CT without contrast is complementary for evaluating osseous causes of compression, particularly facet joint hypertrophy and uncovertebral joint osteophytes. 1, 2
Critical Pitfall to Avoid
Do not operate based on imaging findings alone. Degenerative changes on MRI/CT are ubiquitous in patients over 30 and correlate poorly with symptoms. 1, 2 MRI demonstrates frequent false-positive and false-negative findings, and abnormalities detected are not always associated with acute symptoms. 6
Indications for Surgical Consultation
Consider surgical referral if any of the following occur:
- Persistent disabling symptoms despite 6+ weeks of structured conservative therapy 1, 2
- Clinically significant motor deficits (weakness) that impact functional activities and quality of life 1, 2
- Progressive neurological deterioration despite conservative management 1, 2
- Severe radiculopathy with intractable pain resistant to conservative measures 1, 2
Surgical Outcomes When Conservative Management Fails
If surgery becomes necessary, anterior cervical decompression and fusion (ACDF) is the primary surgical approach:
- 80-90% success rate for arm pain relief 1, 7, 2
- 90.9% functional improvement following surgical intervention 1, 7, 2
- More rapid relief within 3-4 months compared to continued conservative treatment 1, 7, 2
- Motor function recovery maintained in 92.9% of patients over 12 months 7
However, at 12 months, conservative management achieves comparable clinical improvements to surgical interventions, though surgery provides more rapid relief. 7, 2
Treatment Timeline
- Weeks 0-6: Structured conservative management with collar, NSAIDs, physical therapy, activity modification 2
- Week 6: If symptoms persist, obtain MRI cervical spine without contrast 2
- Weeks 6-12: Continue conservative management if no red flags present 2
- Beyond 12 weeks: Consider surgical consultation if persistent disabling symptoms, motor deficits, or progressive neurological deterioration 1, 2