Radicular pain associated with chronic neuropathic pain syndrome. Modern approaches to non-drug treatment

Cover Page
Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


The review presents modern data on epidemiology, mechanisms of pathogenesis, clinical presentation, diagnosis of radicular pain. The indications for surgical treatment, the causes of failures in the treatment of radicular pain syndrome and the issues of its chronicity, as well as the prevention of the development of chronic pain of lumbosacral localization are considered. A generalized list of predictors of outcomes of surgical treatment of radicular pain is presented. Criteria for stage-by-stage diagnostics, physical and instrumental examination of patients with radicular pain in the lower back are presented. Conditions aimed at expanding the range of diagnostic studies, the feasibility of a multidisciplinary approach to the treatment of patients with pain in lumbosacral localization are discussed.

Full Text

Restricted Access

About the authors

Sergey V. Mit'kovskii

FGBUZ «Central Clinical Hospital for Rehabilitation of the Federal Medical and Biological Agency»

Author for correspondence.
Email: mitkovskiy_sergey@mail.ru
ORCID iD: 0000-0002-3949-5448

Russian Federation, Goluboe

Elena S. Kiparisova

Academy of Postgraduate Education of the Federal State Budgetary Institution «Federal Research and Clinical Center of Specialized types of medical care and medical technologies of the Federal Medical and Biological Agency»

Email: mitkovskiy_sergey@mail.ru
SPIN-code: 2841-9154

Russian Federation, Moscow, Russian Federation

DSc., Prof

Andrey V. Kochetkov

Academy of Postgraduate Education of the Federal State Budgetary Institution «Federal Research and Clinical Center of Specialized types of medical care and medical technologies of the Federal Medical and Biological Agency»

Email: mitkovskiy_sergey@mail.ru

Russian Federation, Moscow

DSc., Prof

Valery G. Mit'kovskii

FGBUZ «Central Clinical Hospital for Rehabilitation of the Federal Medical and Biological Agency»; Academy of Postgraduate Education of the Federal State Budgetary Institution «Federal Research and Clinical Center of Specialized types of medical care and medical technologies of the Federal Medical and Biological Agency»

Email: mitkovskiy_sergey@mail.ru
ORCID iD: 0000-0002-0539-3320

Russian Federation, Goluboe; Moscow



  1. Popelenskii YaYu. Diseases of the peripheral nervous system: a guide for doctors. Moscow: Meditsina; 1989. 464 p. (In Russ).
  2. Kolotov YB, Aminov RR, Kolotova YV, et al. The comparative assessment the effectiveness of treatment the nerve root compress syndrome using the anterior and posterior approaches of patients with combined lateral lumbar stenosis. Bulletin of Siberian Medicine. 2013;12(6):103–111. (In Russ). doi: 10.20538/1682-0363-2013-6-103-111
  3. Polishchuk N, et al. Diagnostics and differentiated surgical treatment of spinal canal stenosis of the lumbar spine using microinvasive manipulations. Materials of the IV Congress of Neurosurgeons of Russia, June 18–22. Moscow; 2006. P. 94–95. (In Russ).
  4. Gushcha AO, Konovalov NA, Dreval ON, et al. Clinical recommendations for the diagnosis and treatment of herniated discs of the lumbosacral spine. Moscow: Association of Neurosurgeons of Russia; 2014. (In Russ).
  5. Aganesov AG, Arestov SO, Asyutin DS, et al. Surgery of degenerative lesions of the spine: a national guide. Ed. by A.O. Gushcha, et al. Moscow: GEOTAR-Media; 2019. 478 p. (In Russ).
  6. Boos N, Aebi M, eds. Spinal disorders. Fundamentals of diagnosis and treatment. Berlin: Springer; 2008. P. 165–167.
  7. Kreiner DS, Hwang S, Easa J, et al. Clinical guidelines for multidisciplinary spine care. Diagnosis and treatment of lumbar disc herniation with radiculopathy. North American Spine Society; 2012. 100 р.
  8. Krivoshapkin AL, Nekrasov AD, Semin PA. Lumbar intervertebral disc herniation and alternative locomotion. Novosibirsk: Geo; 2014. 224 p. (In Russ).
  9. Yumashev GS, Furman ME. Osteochondrosis of the spine. 2nd ed. Moscow: Meditsina; 1984. 384 р. (In Russ).
  10. Kremer Yu. Intervertebral disk diseases [Kraemer Ju. Intervertebral disk diseases Stuttgart: New York: Thieme, 2009]: transl. from English A.K. Smirnov. Ed. by V.A. Shirokov. 2nd ed. Moscow: MEDpress-inform; 2015. 471 p. (In Russ).
  11. Fardon DF, Milette PC. Nomenclature and classification of lumbar disc pathology. Recommendation of the Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine. 2001;26(5):E93–E113. doi: 10.1097/00007632-200103010-00006
  12. Greenberg MS. Handbook of neurosurgery. Thieme; 2006. 1013 р.
  13. Davydov OS, Yakhno NN, Kukushkin ML, et al. Neuropathic pain: clinical guidelines on the diagnostics and treatment from the Russian association for the studying of pain. Russian journal of Pain. 2018;(4):5–41. (In Russ). doi: 10.25731/RASP.2018.04.025
  14. Konovalov NA. Novye tekhnologii i algoritmy diagnostiki i khirurgicheskogo lecheniya degenerativnykh zabolevanii poyasnichnogo otdela pozvonochnika [dissertation abstract]. Moscow; 2010. (In Russ).
  15. Pfirrmann CW, Dora C, Schmid MR, et al. MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology. 2004;230(2):583–588. doi: 10.1148/radiol.2302021289
  16. Swartz KR, Trost GR. Recurrent lumbar disc herniation. Neurosurg Focus. 2003;15(3):10. doi: 10.3171/foc.2003.15.3.10
  17. Janssen ME, Bertrand SL, Joe C, Levine MI. Lumbar herniated disk disease: comparison of MRI, myelography, and post-myelographic CT scan with surgical findings. Orthopedics. 1994;17(2):121–127.
  18. Albeck MJ, Taher G, Lauritzen M, Trojaborg W. Diagnostic value of electrophysiological tests in patients with sciatica. Acta Neurol Scand. 2000;101(4):249–254. doi: 10.1034/j.1600-0404.2000.101004249.x
  19. Beyaz EA, Akyuz G, Us O. The role of somatosensory evoked potentials in the diagnosis of lumbosacral radiculopathies. Electromyogr Clin Neurophysiol. 2009;49(4):131–142.
  20. Haig AJ, Geisser ME, Tong HC, et al. Spinal canal size and clinical symptoms among persons diagnosed with lumbar spinal stenosis. Clin J Pain. 2007;23(9):780–785. doi: 10.1097/AJP.0b013e31815349bf
  21. Ilyasevich IA, Shalatonina OI, Soshnikova EV, et al. Neurophysiological research in diagnostics and treatment of degenerative stenosis of the spinal canal. Medicinskie novosti. 2013;(7):55–60. (In Russ).
  22. Yevtushenko SK, Kazaryan NE, Simonyan VA. Method of transcranial magnetic stimulation: new possibilities in diagnosis and rehabilitation of diseases of the nervous system in children and adults. International neurological journal. 2012;(8):22–28. (In Russ).
  23. Rossi S, Hallett M. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol. 2009;120(12):2008–2039. doi: 10.1016/j.clinph.2009.08.016
  24. Blohina VN, Melikjan JeG, Ivanova DS, Daminov VD. Modern approach to rehabilitating patients after operations on the lumbar microdiscectomy level. Bulletin of Pirogov National medical & surgical center. 2014;9(3):88–92. (In Russ).
  25. Daminov VD. Differentsirovannoe primenenie stimulyatsionnykh metodov v kompleksnom vosstanovitel’nom lechenii bol’nykh dorsopatiei posle diskehktomii [dissertation abstract]. Moscow; 2006. (In Russ).
  26. Galimullina AA. Sostoyanie provodyashchikh putei spinnogo mozga u patsientov s vertebrogennymi poyasnichno-kresttsovymi radikulopatiyami [dissertation abstract]. Kazan’; 2007. (In Russ).
  27. Rogozhin AA. Kliniko-neirofiziologicheskaya kharakteristika ostroi kompressionnoi radiokulopatii i obostrenii radikulyarnogo sindroma [dissertation abstract]. Kazan’; 2005. (In Russ).
  28. McMorland G, Suter E, Casha S, et al. Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. J Manipulative Physiol Ther. 2010;33(8):576–584. doi: 10.1016/j.jmpt.2010.08.013
  29. Avdey GM, Kulesh SD, Radilovich NP, et al. Clinical effectiveness of some methods of physiotherapy in the treatment of patients with discogenic radiculopathy. Medicinskie novosti. 2018;(3):44–46. (In Russ).
  30. Mapitoba GK. The transdermal therapy of osteoarthrosis with magnetotherapy using. Medicine and Ecology. 2010;(4):124–125. (In Russ).
  31. Aidarova IA. Physiotherapeutic factors in the treatment of degenerative-dystrophic process of the spine. Neirokhirurgiya i nevrologiya Kazakhstana. 2015;(4):18–21. (In Russ).
  32. Nizard J, Lefaucheur JP, Helbert M, et al. Non-invasive stimulation therapies for the treatment of refractory pain. Discov Med. 2012;14(74):21–31.
  33. Gerasimov AA. Lechenie bol’nykh s distroficheskimi zabolevaniyami sustavov i pozvonochnika sposobom vnutritkanevoi ehlektrostimulyatsii [dissertation abstract]. Saint Petersburg; 1995. (In Russ).
  34. Kalinina SM. Evaluation of the effectiveness of interstitial electrical stimulation (vtes) in the treatment of pain syndromes of the spine and joints [Otsenka ehffektivnosti vnutritkanevoi ehlektrostimulyatsii (VTEHS) v lechenii bolevykh sindromov pozvonochnika i sustavov]. Zdravookhranenie Yugry: opyt i innovatsii. 2015;(1):56–58. (In Russ).
  35. Menshchikova IA. The experience of interstitial electrostimulation use for treatment of orthopaedic-and-traumatological patients. Genij ortopedii. 2006;(1):71–74. (In Russ).
  36. Omar AS, Awadalla MA, El-Latif MA. Evaluation of pulsed electromagnetic field therapy in the management of patients with discogenic lumbar radiculopathy. Int J Rheum Dis. 2012;15(5):e101–e108. doi: 10.1111/j.1756-185X.2012.01745.x
  37. Aamir A, Girach A, Sarrigiannis PG, et al. Repetitive magnetic stimulation for the management of peripheral neuropathic pain: a systematic review. Adv Ther. 2020;37(3):998–1012. doi: 10.1007/s12325-020-01231-2



Abstract - 88

PDF (Russian) - 0


Article Metrics

Metrics Loading ...


  • There are currently no refbacks.

Copyright (c) 2020 Eco-Vector

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies