Research

Pain patterns and descriptions in patients with radicular pain: Does the pain necessarily follow a specific dermatome?

Donald R Murphy^1,2,3 , Eric L Hurwitz⁴ , Jonathan K Gerrard⁵ and Ronald Clary⁶

¹  Rhode Island Spine Center, 600 Pawtucket Ave, Pawtucket, RI 02860-6059, USA

²  Department of Community Health, Alpert Medical School of Brown University, Box G-A, Providence, RI 02912, USA

³  Department of Research, New York Chiropractic College, 2360 State Route 89, Seneca Falls, New York 13148, USA

⁴  Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii, Manoa, Hawaii 96822, USA

⁵  Aquarius Chiropractic, #210 - 179 Davie Street, Vancouver, V6Z 2Y1, Canada

⁶  Private Practice of Chiropractic Medicine, 621 Smith Street, Providence, RI 02908, USA

author email corresponding author email

Chiropractic & Osteopathy 2009, 17:9doi:10.1186/1746-1340-17-9

Published:	21 September 2009

Abstract

Background

It is commonly stated that nerve root pain should be expected to follow a specific dermatome and that this information is useful to make the diagnosis of radiculopathy. There is little evidence in the literature that confirms or denies this statement. The purpose of this study is to describe and discuss the diagnostic utility of the distribution of pain in patients with cervical and lumbar radicular pain.

Methods

Pain drawings and descriptions were assessed in consecutive patients diagnosed with cervical or lumbar nerve root pain. These findings were compared with accepted dermatome maps to determine whether they tended to follow along the involved nerve root's dermatome.

Results

Two hundred twenty-six nerve roots in 169 patients were assessed. Overall, pain related to cervical nerve roots was non-dermatomal in over two-thirds (69.7%) of cases. In the lumbar spine, the pain was non-dermatomal in just under two-thirds (64.1%) of cases. The majority of nerve root levels involved non-dermatomal pain patterns except C4 (60.0% dermatomal) and S1 (64.9% dermatomal). The sensitivity (SE) and specificity (SP) for dermatomal pattern of pain are low for all nerve root levels with the exception of the C4 level (Se 0.60, Sp 0.72) and S1 level (Se 0.65, Sp 0.80), although in the case of the C4 level, the number of subjects was small (n = 5).

Conclusion

In most cases nerve root pain should not be expected to follow along a specific dermatome, and a dermatomal distribution of pain is not a useful historical factor in the diagnosis of radicular pain. The possible exception to this is the S1 nerve root, in which the pain does commonly follow the S1 dermatome.