When you need to better understand your spine diagnosis, being able to distinguish between key terms can make a world of difference in understanding why one course of treatment is recommended and another is not. Terms that describe back pain and its associated conditions are varied and might include sciatica, neuritis, radiculitis, radiculopathy, neuropathy, referred pain, or radiating pain.
One thing is certain: They all have to do with the nervous system in some way.
Causes of Spine Pain
Back pain is frequently due to poor posture and the condition of your soft tissue, which means leading a sedentary life may be the reason your back hurts. Even if you exercise regularly, the movement choices you make throughout the day can disrupt the way muscles, tendons, ligaments, and fascia work together to keep your body aligned.
Posture and the condition of soft tissue also play important roles in injury prevention when you engage in sports or other physical activities.
And then there are the injuries to, and conditions of, the structures of the spinal column itself. These involve bones, discs, and nerves, and are generally more serious than posture and soft tissue-related pain cases. Depending on the diagnosis, structural problems may bring about symptoms related to nerve compression, irritation, or inflammation.1
The Spine’s Relationship to the Nervous System
The spine and the nervous system have a very close relationship. The spinal cord, which is one of the two structures comprising the central nervous system, is housed inside the spinal column in an area known as the spinal canal. The spinal canal and the cord are situated vertically at the center of the column. The spinal cord ends at the junction of the thoracic and lumbar spines.
The peripheral nervous system consists of all of the other nerves within the body. The peripheral nerves extend out to the extremities, equipping them with sensation and movement capabilities.
Nerve roots exit the spinal canal and are part of the peripheral nervous system. The spinal nerve root then exits the spinal column through a hole at the side of the spine called the foramen.2
This branching of nerves from the spinal cord and their subsequent exit out the foramina occurs at every level of the spine. Because the nerve anatomy is well known by doctors and anatomists, this design offers a reproducible pattern, allowing practitioners to test their patients’ leg and back symptoms and trace them back to the spinal level from which they originate. This is a key piece of the diagnostic process for a number of spinal ailments.2
All of this offers a starting point for understanding the area being affected in your case. From there, you can consider causes and distinguishing features, which may help you make the most appropriate treatment decisions for you.
Terms That Describe Nerve Pain
There are many different medical terms you may hear while you're getting your spine diagnosis or going through the treatment process. Many of them sound similar.
Radiculopathy is a bit of an umbrella term, describing any disease process that affects a spinal nerve root. If your doctor informs you that your pain is due to radiculopathy, a number of more specific diagnoses, clinical signs, and symptoms may be included as part of the description.
Common causes of radiculopathy include herniated disc and spinal stenosis, while less common causes may include a synovial cyst or tumor that presses on the nerve root.3 Radiculopathy may occur in the neck, low back, or, more rarely, in the thoracic area.
Quite often, radiculopathy is brought on by some form of compression of the spinal nerve root. For example, extruded material from a herniated disc may land on a nearby spinal nerve root, putting pressure on it. This tends to cause symptoms associated with radiculopathy, including pain, numbness, weakness, or electrical sensations that go down an extremity.3
While the spinal nerve root is the structure that is compressed or irritated in cases of radiculopathy, often the symptoms will be felt elsewhere. Specifically, pain and abnormal sensations are usually felt along the path of the branches that arise from the affected spinal nerve root. This is the reason for symptoms experienced in the extremity.
You may wonder why your symptoms are felt in one extremity but not both. An example might be pain, weakness, and numbness that is present in just one leg.
While there's a spinal nerve root located on either side of the column, injury, trauma, or problems stemming from degeneration do not affect these equally. Degenerative changes, often called "wear and tear," typically occur in an asymmetric fashion. This is similar to a car, where the tires might wear down at a different rates for no obvious reason.
Injury location plays a role, too. Using the herniated disc example again, the material that escapes from the center of the disc structure tends to travel in one direction, but not both. When this is the case, the symptoms will likely be experienced only on the side where the nerve root is contacted by the disc material.4
Radiating or Referred Pain
Radiating pain follows the path of one of the peripheral sensory nerves, which are nerves that carry information about things you feel, such as heat, cold, pain, and the like. The most common cause of radiating pain is impingement (a.k.a. compression) of a spinal nerve root.5
In contrast, referred pain is experienced in a part of the body that is away from the actual source (which is usually an organ).6 It may be due to myofascial trigger points or visceral activity, such as the heart attack example cited above.
Perhaps the best-known example of referred pain is pain in the jaw or arm of someone having a heart attack.6
Other differences between radiating and referred pain: Referred pain tends to be felt generally, while radiating pain is more focused in nature. And referred pain tends to be closer to its source than radiating pain.
Radiculitis is a term that is sometimes used to describe radiculopathy more specifically. The distinction lies in what causes the radiculopathy.
The word radiculitis refers to a spinal nerve root that is inflamed rather than compressed or otherwise irritated. The suffix -itis refers to inflammation. The prefix radicu- refers to the spinal nerve root. Therefore, radiculitis refers to inflammation of the spinal nerve root.
Radiculitis, in general, differs from most cases of radiculopathy in that it is non-compressive.3
Authors of a 2007 study published in the journal Brain Research say that while mechanical factors do contribute to pain from disc herniation, the disc material itself, which often makes contact with the spinal nerve root, is inflammatory. In particular, they say that the nucleus pulposus (the soft, jelly-like substance that is contained in the center of the intervertebral disc and gives the disc its shock-absorbing power) introduces an inflammatory response in the body.7
The authors also comment that sometimes disc surgery meant to “unload the root” doesn’t always have the desired effect, pointing to the possibility that the chemical component is responsible for pain and other symptoms.
Radicular pain is one of the symptoms of radiculopathy. Radicular pain consists of pain that radiates from the spinal nerve root either part or all the way into the extremity.
Many people confuse the terms radicular pain and radiculopathy. Again, radicular pain is a symptom, which means it's something you feel, while radiculopathy is a disease process—that is, it is something that's happening to your body.
Radiculopathy causes radicular pain. But radicular pain does not represent the full symptom spectrum of radiculopathy.
Radiculopathy symptoms also include numbness, weakness, or electrical sensations such as pins and needles, burning, or shock that travel down one extremity.3
Neuropathy is another broad umbrella term. It refers to any dysfunction or disease that affects nerves. It’s usually classified according to either the cause, such as diabetic neuropathy, or the location.
Neuropathy can occur anywhere in the body, including the peripheral nerves, the autonomic nerves (which are nerves that serve organs), or nerves that are located inside the skull and serve your eyes, ears, and more. A well-known example of peripheral neuropathy is carpal tunnel syndrome.8
One spinal condition that is known to cause peripheral neuropathy is spinal stenosis.9 In this condition, changes in the foramina that have a narrowing effect on this space compress the nerves as they exit the spinal column.
With neuropathy, it's sometimes difficult to tell where the trouble really is.
In the carpal tunnel example, the symptoms of tingling, numbness, or weakness in the hand may be coming from nerves compressed by a crosswise band of connective tissue at the wrist called the flexor retinaculum. In this case, the nerves in the extremity are the ones affected, making this condition a neuropathy.
But the same symptoms may be due to an irritation of the spinal nerve root at C-7, for example. In this case, the pain and other effects are due to pain that radiates from the root to the wrist.
Neuropathy can affect many nerves at one time, or just one. When multiple nerves are involved the condition is called polyneuropathy. When it’s just one, it's known as mononeuropathy.10
Neuritis is a type of neuropathy that indicates nerve inflammation.11 As with the term radiculitis, location matters.
The difference between the two “-itises” is that radiculitis refers to inflammation of the spinal nerve root. Neuritis, on the other hand, is typically used to describe inflammation of peripheral nerves after they have exited the spinal column.12
Peripheral nerves are what most people are referring to when they talk about nerves—the (usually) long, thin strands that supply sensation, feeling, and movement impulses to all areas of the body located outside the central nervous system. This includes, but is not limited to, the arms and legs.
Neuritis may lead to radicular pain, as well as to other nerve symptoms.12
Generally, people use the term sciatica to describe symptoms that include radiating pain that goes into the hip, buttock, or leg. One of the most common causes of sciatica is radiculopathy, which is discussed above. Another one is spinal stenosis.13
One of the least common causes is piriformis syndrome, where a tight buttock muscle, the piriformis muscle, constricts the sciatic nerve, which runs just underneath it.14
When it comes to sciatica, the main takeaway is that this term does not definitively tell you where your leg, hip, or buttock pain comes from. It's best to get formally diagnosed before determining which treatment option is the best fit for you.
Pain Prevention and Treatment
Spinal problems that affect nerves are often due to degenerative changes that occur as we age or as a result of an injury. Examples include degenerative disc disease, facet joint hypertrophy, spinal arthritis, spinal stenosis, and hypertrophy
In these cases, prevention may not be possible, but you may be able to slow down the rate of degeneration by maintaining a regular exercise program. Such a program should include range of motion (for example, flexibility or stretching moves), core-strengthening work, and aerobic activity.
Another strategy for diminishing the occurrence of degenerative spinal changes is to prevent injuries before they happen. Again, a well-crafted exercise program may help. You might consider seeing a physical therapist who specializes in either aging patients or arthritis for a program that is tailored to your specific needs.
Treatment for radiculopathy may consist of a combination of pain medication, physical therapy, weight loss to help relieve pressure on nerves, and steroid injections. If these conservative measures fail, surgery may be needed to help decrease or eliminate symptoms