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Lumbar radicular pain — FRCA Final MCQ

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ModeratePain MedicineLumbar radicular painFRCA Final

A 55-year-old man has severe low back pain radiating below the knee for eight weeks. MRI shows an L5/S1 disc prolapse compressing the S1 root. He has no cauda equina symptoms, has tried physiotherapy and analgesics, and wants an intervention to improve leg pain. What is the most appropriate pain management?

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Correct answer: A — Offer image-guided epidural steroid injection for radicular pain

Radicular leg pain from disc prolapse can respond to image-guided epidural steroid injection in selected patients. Facet denervation targets facet-mediated axial back pain rather than nerve-root pain. Long-term opioids and bed rest are poor strategies for subacute radiculopathy. Red-flag neurological deterioration would change the pathway toward urgent surgical review.

Reference: NICE NG59 low back pain and sciatica; Faculty of Pain Medicine Core Standards