Potential Nociceptive Role of the Thoracolumbar Fascia: A Scope Review Involving in Vivo and Ex Vivo Studies

Abstract

Nociceptive innervation of the thoracolumbar fascia (TLF) has been investigated over decades, however these studies have not been compiled or collectively appraised. The purpose of this scoping review was to assess current knowledge regarding nociceptive innervation of the TLF to better inform future mechanistic and clinical TLF research targeting low back pain (LBP) treatment. PubMed, ScienceDirect, Cochrane and Embase databases were searched in January 2021 using relevant descriptors encompassing fascia and pain. Eligible studies were: (a) published in English; (b) preclinical and clinical (in vivo and ex vivo) studies; (c) original data; (d) included quantification of at least one TLF nociceptive component. Two-phase screening procedures were conducted by a pair of independent reviewers, data were extracted and summarized from eligible studies. The search resulted in 257 articles of which 10 met inclusion criteria. Studies showed histological evidence of nociceptive nerve fibers terminating in low back fascia, suggesting a TLF contribution to LBP. Noxious chemical injection or electrical stimulation into fascia resulted in longer pain duration and higher pain intensities than injections into subcutaneous tissue or muscle. Pre-clinical and clinical research provides histological and functional evidence of nociceptive innervation of TLF. Greater knowledge of fascial neurological components could impact LBP treatment.

Influence of sports activity, thoracolumbar fascia morphology and myofascial release treatment on lumbar microcirculation: a randomized, placebo-controlled trial

“…[16] and Mense [5] found a signi cantly increased density of substance P-positive bers in in amed rat TLF. These bers are generally considered to be nociceptive [50] and could lead to higher pain sensitivity, which is also consistent with the strong correlation of TLFM and ODQ-D found at baseline.…”

The incidence and risk factors of lumbodorsal fasciitis in osteoporotic vertebral compression fractures: a retrospective study in 1182 cases

“…Given that lumbodorsal fascia is innervated and could be a potential source of low back pain [6][7][8][9][10][11][12], it is intriguing to understand how lumbodorsal fasciitis will effect on the induction and relief of back pain associated with OVCF. Here we showed that patients with lumbodorsal fasciitis more often complained longer duration of back pain before hospitalization, suggesting a possible contribution of the fasciaoriginated pain to distract patients from the fracture-induced pain.…”

“…In some patients, an edema signal could also be detected subcutaneously dorsal to the thoracolumbar fascia, suggesting a comorbidity of lumbodorsal fasciitis in the OVCF [3][4][5]. While the epidemiology and pathogenesis of lumbodorsal fasciitis remain elusive, evidence accumulates that the lumbodorsal fascia is innervated with terminal nerves and could be a potential source of acute or chronic low back pain [6][7][8][9][10][11][12]. It has been increasingly recognized that the presence of thoracolumbar fascia edema potentially contributes to the residual back pain after percutaneous kyphoplasty [15][16].…”