Current Pain and Headache Reports

, Volume 9, Issue 3, pp 168–177 | Cite as

Neuropathic low back pain

  • Joseph F. Audette
  • Emmanuel Emenike
  • Alec L. Meleger


In this discussion, we hope to advance a clinical approach to low back pain that is more in line with our modern understanding of neuropathic pain. We review the current understanding of normal and pathologic neuroanatomy of the lumbar spine and then outline how pathology in the different structures can lead to neuropathic pain and cause common pain patterns seen in clinical practice. We also detail the available treatments for neuropathic low back pain.


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References and Recommended Reading

  1. 1.
    Atlas SJ, Deyo RA: Evaluating and managing acute low back pain in the primary care setting. J Gen Intern Med 2001, 16:120–131.PubMedCrossRefGoogle Scholar
  2. 2.
    Jensen MC, Brantzawadzki MN, Obuchowski N, et al.: Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994, 331:69–73.PubMedCrossRefGoogle Scholar
  3. 3.
    Parisien RC, Ball PA: William Jason Mixter (1880–1958): Ushering in the “dynasty of the disc.” Spine 1998, 23:2363–2366.PubMedCrossRefGoogle Scholar
  4. 4.
    Merskey H, Bogduk N: Classification of Chronic Pain. Seattle: IASP Press; 1994.Google Scholar
  5. 5.
    Backonja MM: Defining neuropathic pain. Anesth Analg 2003, 97:785–790. Excellent review of the controversy regarding the definition of neuropathic pain.PubMedCrossRefGoogle Scholar
  6. 6.
    Woolf CJ, Costigan M: Transcriptional and post-translational plasticity and the generation of inflammatory pain. Proc Natl Acad Sci U S A 1999, 96:7723–7730.PubMedCrossRefGoogle Scholar
  7. 7.
    Bennett GJ: Neuropathic pain: A crisis of definition? Anesth Analg 2003, 97:619–620. A worthwhile comment to read in response to the review by Backonja [5].PubMedCrossRefGoogle Scholar
  8. 8.
    Johnston HM: The cutaneous branches of the posterior primary divisions of the spinal nerves, and their distribution in the skin. J Anat Physiol 1908, 43:80–91.PubMedGoogle Scholar
  9. 9.
    Maigne JY, Lazareth JP, Guerin Surville H, Maigne R: The lateral cutaneous branches of the dorsal rami of the thoraco-lumbar junction: an anatomical study on 37 dissections. Surg Radiol Anat 1989, 11:289–293.PubMedCrossRefGoogle Scholar
  10. 10.
    Bogduk N, Wilson AS, Tynan W: The human lumbar dorsal rami. J Anat 1982, 134:383–397.PubMedGoogle Scholar
  11. 11.
    Bradley KC: Anatomy of backache. Aust N Z J Surg 1974, 44:227–232.PubMedGoogle Scholar
  12. 12.
    Bogduk N: The nerve supply to the human lumbar vertebral column 2: the dorsal rami. J Anat 1981, 132:316–316.Google Scholar
  13. 13.
    Malinsky J: The ontogenetic development of nerve terminations in the intervertebral discs of man (histology of intervertebral discs, 11th communication). Acta Anat (Basel) 1959, 38:96–113.Google Scholar
  14. 14.
    Groen GJ, Baljet B, Drukker J: Nerves and nerve plexuses of the human vertebral column. Am J Anat 1990, 188:282–296.PubMedCrossRefGoogle Scholar
  15. 15.
    Bogduk N: Clinical Anatomy of the Lumbar Spine and Sacrum, edn 3. New York: Churchill Livingstone; 1997.Google Scholar
  16. 16.
    Bove GM, Light AR: The nervi nervorum: missing link for neuropathic pain? Pain Forum 1997, 6:181–190.Google Scholar
  17. 17.
    Sauer SK, Bove GM, Averbeck B, Reeh PW: Rat peripheral nerve components release calcitonin gene-related peptide and prostaglandin E-2 in response to noxious stimuli: evidence that nervi nervorum are nociceptors. Neuroscience 1999, 92:319–325.PubMedCrossRefGoogle Scholar
  18. 18.
    Freemont AJ, Peacock TE, Goupille P, et al.: Nerve ingrowth into diseased intervertebral disc in chronic back pain. Lancet 1997, 350:178–181.PubMedCrossRefGoogle Scholar
  19. 19.
    Coppes MH, Marani E, Thomeer R, Groen GJ: Innervation of “painful” lumbar discs. Spine 1997, 22:2342–2349.PubMedCrossRefGoogle Scholar
  20. 20.
    Woolf CJ, Salter MW: Neuroscience: neuronal plasticity. Increasing the gain in pain. Science 2000, 288:1765–1768.PubMedCrossRefGoogle Scholar
  21. 21.
    Graven-Nielsen T, Mense S: The peripheral apparatus of muscle pain: evidence from animal and human studies. Clin J Pain 2001, 17:2–10.PubMedCrossRefGoogle Scholar
  22. 22.
    Woolf CJ: Dissecting out mechanisms responsible for peripheral neuropathic pain: implications for diagnosis and therapy. Life Sci 2004, 74:2605–2610.PubMedCrossRefGoogle Scholar
  23. 23.
    Hong CZ, Simons DG: Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points. Arch Phys Med Rehab 1998, 79:863–872.CrossRefGoogle Scholar
  24. 24.
    Audette JF, Wang F, Smith H: Bilateral activation of motor unit potentials with unilateral needle stimulation of active myofascial trigger points. Arch Phys Med Rehab 2004, 83:368–374.CrossRefGoogle Scholar
  25. 25.
    Shah JP, Phillips T, Danoff JV, Gerber LH: A novel microanalytical technique for assaying soft tissue demonstrates significant quantitative biochemical differences in three clinically distinct groups: normal, latent, and active. Arch Phys Med Rehab 2003, 84:9.CrossRefGoogle Scholar
  26. 26.
    Omarker K, Myers RR: Pathogenesis of sciatic pain: role of herniated nucleus pulposus and deformation of spinal nerve root and dorsal root ganglion. Pain 1998, 78:99–105.PubMedCrossRefGoogle Scholar
  27. 27.
    Arnoldi CC, Brodsky AE, Cauchoix J, et al.: Lumbar spinal stenosis and nerve root entrapment syndromes: definition and classification. Clin Orthop 1976, 115:4–5.PubMedGoogle Scholar
  28. 28.
    Kirkaldy-Willis WH, Paine KW, Cauchoix J, McIvor G: Lumbar spinal stenosis. Clin Orthop 1974, 99:30–50.PubMedCrossRefGoogle Scholar
  29. 29.
    Wiltse LL, Newman PH, Macnab I: Classification of spondylolysis and spondylolisthesis. Clin Orthop 1976, 117:23–29.PubMedGoogle Scholar
  30. 30.
    Dreyer SJ, Dreyfuss PH: Low back pain and the zygapophysial (facet) joints. Arch Phys Med Rehab 1996, 77:290–300.CrossRefGoogle Scholar
  31. 31.
    Fukui S, Ohseto K, Shiotani M, et al.: Distribution of referred pain from the lumbar zygapophysial joints and dorsal rami. Clin J Pain 1997, 13:303–307.PubMedCrossRefGoogle Scholar
  32. 32.
    Mendell JR, Sahenk Z: Painful sensory neuropathy. N Engl J Med 2003, 348:1243–1255. A succinct, but thorough review of the differential diagnosis of painful neuropathies.PubMedCrossRefGoogle Scholar
  33. 33.
    Nachemson AL, Jonsson E: Neck and Back Pain: The Scientific Evidence of Causes, Diagnosis, and Treatment. Philadelphia: Lippincott Williams & Wilkins; 2000.Google Scholar
  34. 34.
    Turk DC: Cognitive-behavioral approach to the treatment of chronic pain patients. Reg Anesth Pain Med 2003, 28:573–579.PubMedCrossRefGoogle Scholar
  35. 35.
    Dworkin RH, Backonja M, Rowbotham MC, et al.: Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Arch Neurol 2003, 60:1524–1534.PubMedCrossRefGoogle Scholar
  36. 36.
    McQuay HJ, Tramer M, Nye BA, et al.: Systematic review of antidepressants in neuropathic pain. Pain 1996, 68:217–227.PubMedCrossRefGoogle Scholar
  37. 37.
    Schofferman J: Long-term opioid analgesic therapy for severe refractory lumbar spine pain. Clin J Pain 1999, 15:136–140.PubMedCrossRefGoogle Scholar
  38. 38.
    Fishman SM, Wilsey B, Mahajan G, Molina P: Methadone reincarnated: novel clinical applications with related concerns. Pain Med 2002, 3:339–348.PubMedCrossRefGoogle Scholar
  39. 39.
    Schmidt AP, Schmidt SR: How effective are opioids in relieving neuropathic pain? Pain Clin 2002, 14:183–193.CrossRefGoogle Scholar
  40. 40.
    Kalso E, Edwards JE, Moore RA, McQuay HJ: Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain 2004, 112:372–380. A good review article for more depth regarding the use of opioids for noncancer pain.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2005

Authors and Affiliations

  • Joseph F. Audette
    • 1
  • Emmanuel Emenike
  • Alec L. Meleger
  1. 1.Department of Physical Medicine and Rehabilitation, Outpatient Pain ServicesSpaulding Rehabilitation HospitalBostonUSA

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