title: Anatomy, physiology and neurobiology of the nociception: a focus on low back pain (part A).
abstract: BACKGROUND
  The treatment of Failed Back Surgery Syndrome (FBSS) remains a challenge for pain medicine due to the complexity in the interactions between [1] a residual mechanical pain after surgery and, [2] a progressive transition into chronic pain involving central nervous system plasticity and molecular reorganization. The aim of this paper is to provide a fundamental overview of the pain pathway supporting the nociceptive component of the back pain.
  
  
  METHODS
  Literature searches included an exhaustive review of 643 references and 74 book chapters updated by searching the major electronic databases from 1930 to August 2013.
  
  
  RESULTS
  Pain input is gathered by the peripheral fibre from the innervated tissue's environment and relayed by two contiguous central axons to the brain, via the spinal cord. At this level, it is possible to characterize physical pain and emotional pain. These are supported by two different pathways, encoding two dimensions of pain perception: In Neo-spino-thalamic pathway, the wide dynamic range neuron system is able to provide the information needed for mapping the "sensory-discriminative" dimension of pain. The second projection system (Paleo-spino-thalamic pathway) also involves the ventromedial thalamus but projects to the amygdala, the insula and the anterior cingulate cortex. These areas are associated with emotionality and affect.
  
  
  CONCLUSIONS
  The mechanical component of FBSS cannot be understood unless the functioning of the pain system is known. But ultimately, the highly variable nature of back pain expression among individuals would require a careful pathophysiological dissection of the potential generators of back pain to guide pain management strategies.
authors.affiliation: Department of Neurosurgery, Lyon University hospital, 69677 Lyon cedex, France; Laboratory of Anatomy, Faculty of Medicine, 69677 Lyon cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Mertens
authors.affiliation: Department of Neurosurgery, Lille University Hospital, 59037 Lille cedex , France.
authors.forename: S
authors.initials: S
authors.lastname: Blond
authors.affiliation: Service de neurochirurgie, unité rachis et neurostimulation, Poitiers University Hospital, 2, rue de la Milétrie, 86021 Poitiers cedex, France; N(3)Lab: Neuromodulation & Neural Networks, Poitiers University Hospital, Poitiers, France.
authors.forename: R
authors.initials: R
authors.lastname: David
authors.affiliation: Service de neurochirurgie, unité rachis et neurostimulation, Poitiers University Hospital, 2, rue de la Milétrie, 86021 Poitiers cedex, France; N(3)Lab: Neuromodulation & Neural Networks, Poitiers University Hospital, Poitiers, France; Inserm CIC 802, 86021 Poitiers, France. Electronic address: philipperigoard@yahoo.fr.
authors.forename: P
authors.initials: P
authors.lastname: Rigoard
mesh_terms: D055111:Failed Back Surgery Syndrome / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D017116:Low Back Pain / Q000473:pathology* / Q000503:physiopathology; D009434:Neural Pathways / Q000473:pathology / Q000503:physiopathology; D059225:Nociception; D009619:Nociceptors; D010146:Pain / Q000503:physiopathology; D058748:Pain Perception
keywords: Back pain; Douleur aiguë; Failed back surgery syndrome; Lombalgies; Lombo-radiculalgies chroniques post-opératoires; Nociception; Pain; Pain perception; Pathophysiology; Perception de la douleur; Physiopathologie