Differentiating Radicular and Referred Pain in Cervical Spine Disorders
- Author:
Jang Hyuk CHO
1
Author Information
- Publication Type:Review Article
- From: Clinical Pain 2025;24(1):75-78
- CountryRepublic of Korea
- Language:English
- Abstract: Cervical radicular pain and referred pain represent two distinct clinical syndromes commonly encountered in the context of cervical spine pathology. Cervical radicular pain is classified as a neuropathic condition, resulting from mechanical compression or chemical irritation of the dorsal root ganglion (DRG) or cervical spinal nerve root. Such irritation induces ectopic discharges in Aβ and C fibers, often mediated by inflammatory cytokines resulting in sharp, electric-like pain radiating into the upper extremity. Notably, this pain does not conform to a classic dermatomal pattern but more closely aligns with the segmental innervation of deep musculoskeletal structures. In contrast, cervical referred pain arises from non-neural deep somatic tissues such as intervertebral discs, zygapophysial joints, or cervical musculature. It is mediated by spinal convergence of somatic afferents onto shared dorsal horn neurons, often compounded by central sensitization and dichotomizing afferent fibers. These mechanisms lead to spatial mislocalization of pain, which is typically experienced as dull, diffuse, and poorly localized, without accompanying neurological deficits. Experimental and clinical studies demonstrate that nerve root compression alone does not provoke pain unless the DRG is involved, whereas stimulation of deep cervical structures can evoke widespread, non-dermatomal pain. Understanding the distinct pathophysiological basis of cervical radicular and referred pain is essential for accurate diagnosis, clinical differentiation and the implementation of mechanism-targeted treatment strategies in patients with neck pain.
