Important Clinical Distinctions: Nerve Pain and Root Pain.

Nerve root pain is usually brief, sharp and shooting, often increased by coughing or straining, standing or sitting, and usually relieved by lying down. In comparison, pain originating in the peripheral nerves or lumbosacral plexus tends to be described as burning, like

Table 1: Red flags in the evaluation of Low Back Pain that may point to a more serious disorder

Possible condition Findings from Medical history

Fracture Major trauma (motor vehicle accident, fall from height)

Minor trauma or strenuous lifting in an older or osteoporotic patient

Tumor or infection age>

History of cancer

Constitutional symptoms (fever, chills, unexplained

Recent bacterial infection

Intravenous drug use

Immunosuppression (corticosteroid use, transplant recipient, HIV infection)

Pain worse at night or in the supine position

Cauda equina syndrome Saddle anesthesia

Recent onset of bladder dysfunction

Severe or progressive neurologic deficit in the lower extremity

Table 2: Differences between root pain and nerve pain

Characteristic Root pain Nerve pain

Duration Brief Persistent

Quality Sharp, shooting Burning, numb

Aggravating factor Coughing,straining, Lying in bed, standing, lifting

Releived by Lying down pins and needles, "asleep" or numb in quality; it is usually worse when the patient is lying in bed at night. (Table 2)