Cluneal nerve neuropathy

Cluneal nerve neuropathy is a little-known but not uncommon cause of lower back pain, often confused with sciatica or sacroiliac joint problems.
It is caused by irritation or compression of the cluneal nerves, small nerves that run through the muscles and ligaments at the back of the pelvis and carry sensation to an area that includes the lower back, buttocks, and sometimes even the upper thigh.

What are the symptoms?

Pain localized in the lower back, usually on one side only
Pain or tingling that radiates toward the buttock or back of the thigh
Worsening of pain with prolonged sitting, walking, or certain back movements
A very sensitive spot on the edge of the iliac bone (the “ridge” of the pelvis)

How is the diagnosis made?

There are no specific blood tests or X-rays for this condition. Diagnosis is based on:

Careful clinical examination by a pain specialist
Presence of a specific painful point on the iliac crest (often with the so-called “positive Tinel’s sign”)
Performing a diagnostic block: a small amount of local anesthetic is injected into the suspected area. If the pain temporarily disappears, the diagnosis is confirmed.

What treatments are available?

1. Blockage of the cluneal nerves

A small ultrasound-guided injection with local anesthetic and cortisone. This can be used both to confirm the diagnosis and to relieve pain for a few weeks or months.

2. Radiofrequency ablation of the cluneal nerves

It is a minimally invasive treatment performed with fluoroscopic and/or ultrasound guidance.
A special needle is used to emit controlled heat (80°C) at three points along the nerve to selectively interrupt pain signals (without affecting movement, as these are only sensory nerves).

3. Peripheral nerve stimulation

A technique used in resistant cases, in which a small electrode is implanted near the nerve to reduce pain.

4. High-concentration capsaicin patch (8%)

Topical application that may help reduce sensitivity and pain in the area in some cases.

5. Nerve decompression surgery

In very select cases that are resistant to conservative treatments, it is possible to surgically release the compressed nerve.

Conclusione

Cluneal nerve neuropathy is an often overlooked cause of lower back pain. Recognizing it is essential because, once correctly identified, it can be treated with good results, significantly improving the patient’s quality of life.

Lifestyle Interventions

Attività fisica (passeggiate, stretching), sonno regolare, alimentazione equilibrata e tecniche di riduzione dello stress possono migliorare la resilienza e potenziare l’efficacia delle terapie mediche.

Psychological Support

The management of chronic pain can be aided by psychological interventions (such as relaxation techniques or cognitive behavioral therapy), which help reduce anxiety, insomnia, and the impact of pain on quality of life.