The Anatomical Basis for Low Back Pain: Studies on the presence of sensory nerve endings in ligamentous, capsular and intervertebral disc structures in the human lumbar spine

Hirsch, Carl; Ingelmark, Bo-Eric; Miller, Malcolme

doi:10.3109/17453676308999829

Cited by 369 publications

(89 citation statements)

References 5 publications

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“…Although radiculopathy and radicular pain often accompany one another, radiculopathy has been observed in the absence of pain, and radicular pain may happen in the absence of radiculopathy 46, 47 . It is important to underline that, contrary to popular belief, it is not possible to make a distinction among the patterns of L4, L5, and S1 radicular pain 48, 49 . In fact, only when radiculopathy is seen together with radicular pain can segments be estimated.…”

Section: Type Of Spinal Pain According To Pain Generatormentioning

confidence: 85%

Mechanisms of low back pain: a guide for diagnosis and therapy

et al. 2016

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Chronic low back pain (CLBP) is a chronic pain syndrome in the lower back region, lasting for at least 3 months. CLBP represents the second leading cause of disability worldwide being a major welfare and economic problem. The prevalence of CLBP in adults has increased more than 100% in the last decade and continues to increase dramatically in the aging population, affecting both men and women in all ethnic groups, with a significant impact on functional capacity and occupational activities. It can also be influenced by psychological factors, such as stress, depression and/or anxiety. Given this complexity, the diagnostic evaluation of patients with CLBP can be very challenging and requires complex clinical decision-making. Answering the question “what is the pain generator” among the several structures potentially involved in CLBP is a key factor in the management of these patients, since a mis-diagnosis can generate therapeutical mistakes. Traditionally, the notion that the etiology of 80% to 90% of LBP cases is unknown has been mistaken perpetuated across decades. In most cases, low back pain can be attributed to specific pain generator, with its own characteristics and with different therapeutical opportunity. Here we discuss about radicular pain, facet Joint pain, sacro-iliac pain, pain related to lumbar stenosis, discogenic pain. Our article aims to offer to the clinicians a simple guidance to identify pain generators in a safer and faster way, relying a correct diagnosis and further therapeutical approach.

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Section: Type Of Spinal Pain According To Pain Generatormentioning

confidence: 85%

Mechanisms of low back pain: a guide for diagnosis and therapy

et al. 2016

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“…Many studies have described the existence of sensory nerve endings in the annulus fibrosus 13,14) . It is believed that such nerve endings originate from the sinu-vertebral nerves branching from the ventral ramus of the spinal nerve and the ramus communicans of the corresponding level 9,10) .…”

Section: Innervationmentioning

confidence: 99%

Sensory nerve ingrowth, cytokines, and instability of discogenic low back pain: A review

Ohtori

Miyagi

Inoue

2018

Spine Surg Relat Res

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Abstract:Introduction: Many patients suffer from discogenic low back pain. However, the mechanisms, diagnosistic strategy, and treatment of discogenic low back pain all remain controversial. The purpose of this paper was to review the pathological mechanisms of discogenic low back pain.Methods: Many authors have investigated the pathological mechanisms of discogenic low back pain using animal models and examining human patients. Central to most investigations is understanding the innervation and instabilities of diseased intervertebral discs and the role of inflammatory mediators. We discuss three pathological mechanisms of discogenic low back pain: innervation, inflammation, and mechanical hypermobility of the intervertebral disc.Results: Sensory nerve fibers include C-fibers and A delta-fibers, which relay pain signals from the innervated outer layers of the intervertebral disc under normal conditions. However, ingrowth of these sensory nerve fibers into the inner layers of intervertebral disc occurs under disease conditions. Levels of neurotrophic factors and some cytokines are significantly higher in diseased discs than in normal discs. Stablization of the segmental hypermobility, which can be induced by intervertebral disc degeneration, suppresses inflammation and prevents sensitization of sensory nerve fibers innervating the disc.Conclusions: Pathological mechanisms of discogenic low back pain include sensory nerve ingrowth into inner layers of the intervertebral disc, upregulation of neurotrophic factors and cytokines, and instability. Inhibition of these mechanisms is important in the treatment of discogenic low back pain.

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“…Injection of hypertonic saline into the facet joints results in pain which corresponds to the tertiary of that particular facet joint and this pain is reproducible [7,8]. Maps of pain distribution after facet injections have been made by fixed pain patterns in volunteers and patients which help in diagnosis of affected facet joint causing pain.…”

Section: Facet As "Pain Generator"mentioning

confidence: 99%

Low Back Pain due to Lumbar Facet Joint Arthropathy and its Management

Jadon¹

2016

Gen Med (Los Angeles)

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Low back pain is a very common problem which brings a patient to orthopedic clinic or pain clinic. It is estimated that it affects about 60-80% of general population in the whole life and facet joints are responsible for back pain in 15%-45% of such cases. Multimodal approach including analgesics and back strengthening exercise are primary treatments. However, sustained relief can be achieved by radiofrequency ablation after proper diagnosis.

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The Anatomical Basis for Low Back Pain: Studies on the presence of sensory nerve endings in ligamentous, capsular and intervertebral disc structures in the human lumbar spine

Cited by 369 publications

References 5 publications

Mechanisms of low back pain: a guide for diagnosis and therapy

Mechanisms of low back pain: a guide for diagnosis and therapy

Sensory nerve ingrowth, cytokines, and instability of discogenic low back pain: A review

Low Back Pain due to Lumbar Facet Joint Arthropathy and its Management

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