Nerve root injuries in patients with chronic low back pain.
In conclusion, the nerve roots and the DRG play an important role in the pain mechanisms of patients suffering from chronic low back pain. Signs of demyelination and increased sensitization for stimuli occurs after a direct nerve root trauma, and the plasticity for the DRG also may change the response to a given peripheral stimuli when repeated frequently over a long period of time. The regeneration mechanisms of spinal nerve roots and DRG regarding function are slow, and the final grade of recurrence depends on the degree of injury. The limited regeneration mechanisms for nerve injury and the fact that "established chronic pain centers" are hard to influence after a long pain history favor an aggressive strategy for pain management. Today, a number of treatment strategies exist for chronic low back pain patients (with or without a diagnosed nerve root injury). These strategies include physiotherapy, nonsteroid anti-inflammatory drugs (NSAIDs), steroids, analgesics of different types and administration routes, surgery, and other sorts of invasive treatments. Further knowledge about the nerve root, DRG, and the rest of the nervous system in these patients is necessary; for understanding how and when to treat patients with chronic low back pain, we need to understand more about what we are trying to treat.
Brisby
Helena
H
Department of Orthopedics, Sahlgrenska University Hospital, Göteborg University, Göteborg 413 45, Sweden. helena.brisby@orthop.gu.se
D002908:Chronic Disease; D006801:Humans; D017116:Low Back Pain / Q000209:etiology* / Q000503:physiopathology* / Q000628:therapy; D013126:Spinal Nerve Roots / Q000293:injuries*