L86 Back syndrome with radiating pain (ICD-10:M54.1)

Introduction

Back syndrome with radiating pain, also known as radiculopathy, is a condition characterized by pain that radiates from the back into the legs or arms. It is often caused by compression or irritation of the spinal nerves.^[1] This guide aims to provide a comprehensive overview of the symptoms, causes, diagnostic steps, possible interventions, and lifestyle interventions for back syndrome with radiating pain.

Codes

• ICPC-2 Code: L86 Back syndrome with radiating pain^[2]
• ICD-10 Code: M54.1 Radiculopathy^[3]

Symptoms

• Back pain: Dull, aching, or sharp pain in the back.^[4]
• Radiating pain: Pain that travels from the back into the legs or arms.^[5]
• Numbness or tingling: Sensations of numbness or tingling in the legs or arms.^[6]
• Muscle weakness: Weakness or difficulty in moving the legs or arms.^[7]
• Loss of reflexes: Diminished or absent reflexes in the affected area.^[8]
• Limited range of motion: Difficulty in bending, twisting, or moving the back.^[9]

Causes

• Herniated disc: A disc in the spine that bulges or ruptures, putting pressure on the spinal nerves.^[10]
• Spinal stenosis: Narrowing of the spinal canal, causing compression of the spinal nerves.
• Degenerative disc disease: Wear and tear of the discs in the spine, leading to nerve compression.
• Spondylolisthesis: Slippage of one vertebra over another, causing nerve compression.
• Sciatica: Compression or irritation of the sciatic nerve, leading to radiating pain.

Diagnostic Steps

Medical History

• Gather information about the patient’s symptoms, including the location, duration, and severity of pain.
• Identify any risk factors, such as previous back injuries, occupation, or family history of back problems.
• Assess the impact of the pain on the patient’s daily activities and quality of life.

Physical Examination

• Perform a thorough physical examination, including a neurological assessment to evaluate muscle strength, reflexes, and sensation.
• Palpate the spine to identify any areas of tenderness or deformity.
• Observe the patient’s posture, gait, and range of motion to assess any abnormalities.

Laboratory Tests

• Blood tests: May be done to rule out other conditions, such as infections or inflammatory diseases.
• Erythrocyte sedimentation rate (ESR): Elevated ESR may indicate inflammation in the body.
• C-reactive protein (CRP): Elevated CRP levels may suggest inflammation or infection.

Diagnostic Imaging

• X-rays: Can help identify any structural abnormalities, such as fractures, tumors, or degenerative changes in the spine.
• Magnetic resonance imaging (MRI): Provides detailed images of the spine and can detect herniated discs, spinal stenosis, or nerve compression.
• Computed tomography (CT) scan: Useful for evaluating bony structures and identifying fractures or spinal abnormalities.
• Electromyography (EMG): Measures the electrical activity of muscles and can help determine if there is nerve damage or compression.

Other Tests

• Nerve conduction studies: Measures the speed and strength of electrical signals in the nerves to assess nerve function.
• Discography: Involves injecting a contrast dye into the discs to identify any abnormalities or sources of pain.
• Myelogram: Involves injecting a contrast dye into the spinal canal to visualize the spinal cord and nerves.

Follow-up and Patient Education

• Schedule follow-up appointments to monitor the patient’s progress and adjust treatment as necessary.
• Provide education on proper body mechanics, posture, and exercises to improve strength and flexibility.
• Discuss the importance of maintaining a healthy lifestyle, including regular exercise, weight management, and smoking cessation.

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for Back syndrome with radiating pain:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., Ibuprofen, Naproxen):
   • Cost: Generic versions can be $3-$20/month.
   • Contraindications: History of gastrointestinal bleeding, kidney disease.
   • Side effects: Upset stomach, heartburn, increased risk of bleeding.
   • Severe side effects: Stomach ulcers, kidney damage, allergic reactions.
   • Drug interactions: Blood thinners, corticosteroids.
   • Warning: Prolonged use may increase the risk of cardiovascular events.
2. Muscle relaxants (e.g., Cyclobenzaprine, Methocarbamol):
   • Cost: Generic versions can be $10-$30/month.
   • Contraindications: Glaucoma, urinary retention.
   • Side effects: Drowsiness, dizziness, dry mouth.
   • Severe side effects: Severe allergic reactions, liver toxicity.
   • Drug interactions: Sedatives, alcohol.
   • Warning: May cause drowsiness, avoid driving or operating heavy machinery.
3. Gabapentin:
   • Cost: Generic versions can be $10-$30/month.
   • Contraindications: Hypersensitivity to gabapentin.
   • Side effects: Dizziness, drowsiness, peripheral edema.
   • Severe side effects: Suicidal thoughts, severe allergic reactions.
   • Drug interactions: Antacids, opioids.
   • Warning: May cause drowsiness, avoid driving or operating heavy machinery.
4. Tricyclic antidepressants (e.g., Amitriptyline, Nortriptyline):
   • Cost: Generic versions can be $10-$30/month.
   • Contraindications: Recent heart attack, glaucoma.
   • Side effects: Dry mouth, constipation, drowsiness.
   • Severe side effects: Irregular heart rhythm, seizures.
   • Drug interactions: Monoamine oxidase inhibitors (MAOIs), anticoagulants.
   • Warning: May cause drowsiness, avoid driving or operating heavy machinery.
5. Opioids (e.g., Oxycodone, Hydrocodone):
   • Cost: Generic versions can be $20-$100/month.
   • Contraindications: Respiratory depression, acute asthma.
   • Side effects: Constipation, drowsiness, nausea.
   • Severe side effects: Respiratory depression, addiction, overdose.
   • Drug interactions: Benzodiazepines, alcohol.
   • Warning: High risk of dependence and addiction, use with caution.

Alternative Drugs:

• Steroid injections: Intra-articular or epidural steroid injections can provide temporary relief from pain and inflammation. Cost: $100-$500 per injection.
• Anticonvulsants: Medications such as pregabalin or carbamazepine can be used to manage neuropathic pain. Cost: $50-$200/month.
• Topical analgesics: Creams or patches containing lidocaine or capsaicin can provide localized pain relief. Cost: $10-$50 per tube or patch.
• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) can help manage chronic pain. Cost: $10-$50/month.
• Physical therapy: Involves exercises, stretches, and manual therapy techniques to improve strength, flexibility, and posture. Cost: $50-$200 per session.

Surgical Procedures:

• Microdiscectomy: Surgical removal of the herniated portion of a disc to relieve nerve compression. Cost: $20,000 to $50,000.
• Laminectomy: Surgical removal of the lamina to relieve pressure on the spinal cord or nerves. Cost: $50,000 to $100,000.
• Spinal fusion: Surgical procedure to join two or more vertebrae together to stabilize the spine. Cost: $80,000 to $150,000.

Alternative Interventions

• Acupuncture: May help reduce pain and improve function. Cost: $60-$120 per session.
• Chiropractic care: Involves manual adjustments to the spine to relieve pain and improve spinal alignment. Cost: $50-$200 per session.
• Massage therapy: Can help relax muscles, improve circulation, and reduce pain. Cost: $50-$100 per session.
• Yoga: Incorporates stretching, strengthening, and relaxation techniques to improve flexibility and reduce pain. Cost: $10-$20 per class.
• Transcutaneous electrical nerve stimulation (TENS): Involves the use of low-voltage electrical currents to relieve pain. Cost: $50-$100 for a TENS unit.

Lifestyle Interventions

• Exercise: Regular physical activity, such as walking, swimming, or cycling, can help strengthen the back muscles and improve flexibility. Cost: Varies (e.g., gym membership, equipment).
• Weight management: Maintaining a healthy weight can reduce stress on the spine and improve overall back health. Cost: Varies (e.g., healthy food choices, weight loss programs).
• Posture correction: Practicing good posture and using ergonomic furniture can help alleviate back pain. Cost: Varies (e.g., ergonomic chair, lumbar support).
• Heat and cold therapy: Applying heat or cold packs to the affected area can help reduce pain and inflammation. Cost: $10-$30 for heat or cold packs.
• Stress management: Techniques such as deep breathing, meditation, or yoga can help reduce stress and tension in the back. Cost: Varies (e.g., meditation app, yoga classes).

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions. It is recommended to consult with a healthcare professional for personalized treatment options and cost estimates.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – L86 Back syndrome with radiating pain (ICD-10:M54.1)

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Back syndrome with radiating pain effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Back syndrome with radiating pain. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Saleem, S., Aslam, H. M., Rehmani, M. A., Raees, A., Alvi, A. A., & Ashraf, J. (2013). Lumbar disc degenerative disease: disc degeneration symptoms and magnetic resonance image findings. Asian spine journal, 7(4), 322–334. https://doi.org/10.4184/asj.2013.7.4.322
2. ICPC-2 PLUS terminology to develop a classification system for chiropractic. (2013). Chiropractic & manual therapies, 21(1), 4. https://doi.org/10.1186/2045-709X-21-4
3. ICD-10 code: M54.1 Radiculopathy – gesund.bund.de. (n.d.). Gesund.Bund.De. https://gesund.bund.de/en/icd-code-search/m54-1
4. Jeffords, P. (n.d.). Lumbar Radiculopathy (“Sciatica”) and Herniated Disc. Paul Jeffords, MD. https://www.pauljeffordsmd.com/lumbar-radiculopathy-sciatica-and-herniated-disc
5. Radiating Back Pain: Causes, Diagnosis, Treatment – K Health. (n.d.). K Health. https://khealth.com/learn/symptom/radiating-back-pain/
6. Jeffords, P. (n.d.). Lumbar Radiculopathy (“Sciatica”) and Herniated Disc. Paul Jeffords, MD. https://www.pauljeffordsmd.com/lumbar-radiculopathy-sciatica-and-herniated-disc
7. Spine conditions: degenerative disc disease and sciatica. (2017, September 18). OrthoIndy. https://blog.orthoindy.com/2017/09/18/degenerative-disc-disease-and-sciatica/
8. Ebell, M. H. (2000). Diagnosis and Management of Acute Low Back Pain. American Family Physician, 61(6), 1779–1786. https://www.aafp.org/pubs/afp/issues/2000/0315/p1779.html
9. Getting an Accurate Back Pain Diagnosis – Spine-health. (n.d.). Spine-Health. https://www.spine-health.com/treatment/diagnostic-tests/getting-accurate-back-pain-diagnosis
10. Lumbar Radiculopathy – Physiopedia. https://www.physio-pedia.com/Lumbar_Radiculopathy