Shingles That Mimic Lumbar Disc Pain — A Case from My Clinic

by Son’s Rehabilitation Medicine & Chiropractic Clinic in Seoul

A few days ago, a 60-year-old woman visited my clinic with severe radiating pain in her right lower limb.
She described the pain as sharp, electric, and spreading from the groin area down the leg.
Naturally, she suspected a lumbar disc problem, and this is a common assumption among many patients with similar symptoms.

However, after asking her to change clothes for a detailed examination, I noticed distinctive skin eruptions along the right groin area.
This finding immediately shifted the diagnosis from a lumbar disc disorder to herpes zoster (shingles).

Why Shingles Can Be Mistaken for a Lumbar Disc Problem

Shingles causes inflammation along a specific sensory nerve root, leading to pain that follows the same dermatome pattern as radiculopathy.

When the L1–L2 dermatomes are affected, shingles can cause:

  • Groin pain

  • Lower abdominal or flank discomfort

  • Radiating pain toward the inner thigh

These symptoms closely resemble lumbar radiculopathy, especially when the skin rash has not yet fully appeared.

In fact, some patients experience days of severe nerve pain before any rash becomes visible.

Clinical Clue: Always Examine the Skin

In this case, the patient showed:

  • Unilateral groin-to-thigh skin rash

  • Dermatomal distribution consistent with L1–L2 involvement

  • No neurological deficits typically seen in lumbar disc herniation

By combining these findings, it became clear that the pain originated from herpes zoster, not from the spine.

Early Antiviral Treatment Matters

Once shingles is diagnosed, starting antiviral medication within 72 hours is essential.
Early treatment helps:

  • Reduce the severity and duration of symptoms

  • Promote faster recovery of skin lesions

  • Lower the risk of postherpetic neuralgia (PHN)

The patient received antiviral therapy immediately along with supportive pain control.

How to Distinguish Lumbar Disc Pain from Shingles

FeatureLumbar Disc HerniationShingles (Herpes Zoster)
Pain triggerWorse with movement, coughingConstant burning or stabbing pain
Neurologic signsPossible sensory/motor deficitsUsually normal
Skin findingsNormalUnilateral rash along a dermatome
TreatmentConservative therapy, injectionsAntiviral medication is essential

Whenever a patient presents with groin pain plus radiating leg pain, shingles involving the upper lumbar dermatomes should always be considered.

Conclusion

Not all radiating leg pain originates from the spine.
Shingles, especially in the L1–L2 dermatomes, can closely mimic a lumbar disc condition.

A careful clinical examination—including inspection of the skin—plays a crucial role in distinguishing between these two conditions and providing appropriate treatment.

👍Consultation and Appointment Information

Son PMR & Chiropractic Clinic( 2nd floor, 229-1 Gucheonmyun-Ro, Gangdongu, Seoul, South Korea) 

by  Dr Son MD & DC 
Contact: 02-482-8875 in Seoul( +82-2-482-8875)

chson@daum.net



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